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Cheryl Ho
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MA14 - Survivorship, Socioeconomic and End-of-Life Considerations (ID 915)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 2
- Moderators:
- Coordinates: 9/25/2018, 10:30 - 12:00, Room 205 BD
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MA14.05 - Social Isolation Increases Psychological Distress in Patients With NSCLC (ID 11959)
11:00 - 11:05 | Presenting Author(s): Cheryl Ho
- Abstract
- Presentation
Background
The Psychosocial Screen for Cancer (PSSCAN-R) questionnaire is a validated screening tool used to identify the psychosocial needs of patients with cancer. The questionnaire assesses patients’ perceived social supports and identifies patients at risk for developing psychological distress. The study goal was to examine patients with NSCLC who reported risk factors for social isolation and their risk for developing psychological distress.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patients with NSCLC referred to BC Cancer from 2011-2015 who completed a prospective PSSCAN-R questionnaire at the time of first visit were included in the study. Perceived social support questions include: if patients live alone, lost a life partner recently, have no help with IADLs, have no regular contact with friends and family or have no emotional support from others. Demographics were collected retrospectively. Chi-squared test and logistical regression were used to compare patient groups based on age, gender and perceived social support factors.
4c3880bb027f159e801041b1021e88e8 Result
The study cohort was comprised of 4428 patients who completed the PSSCAN-R questionnaire. Female 50%, patients ≥65 years 69%, live alone 29%, lost life partner 13%, no help with IADLs 9%, no regular contact 3% and no emotional support 5%.
8eea62084ca7e541d918e823422bd82e Conclusion
Female patients and patients younger than 65 are more at risk for developing moderate to severe anxiety and depression. Lack of perceived social support also contributes to the risk of developing psychological distress. In addition to developing gender and age-based resources for patients addressing their psychosocial needs, greater efforts in assessing patients’ perceived social supports and allocating community and institutional resources to isolated patients should also become an important part of the patients’ comprehensive and holistic care.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA14.07 - The Impact of Socioeconomic Status and Geographic Location on Palliative Chemotherapy Uptake in Patients with Metastatic NSCLC (ID 13098)
11:10 - 11:15 | Author(s): Cheryl Ho
- Abstract
- Presentation
Background
Socioeconomic status (SES) and geographic factors may impact patient treatment choices. Canada has a publically funded health care system and in BC, there are 35 community oncology network sites that delivery treatment in patients’ local communities. We studied the impact between SES and geographic location upon delivery of chemotherapy/survival in metastatic NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patients with metastatic NSCLC referred to BC Cancer centres from 2011-2015, who completed a prospective Canadian Problem Checklist questionnaire at the time of their first visit and for which chemotherapy data was available were included in the study. The CPC assesses patient distress in 6 domains including practical aspects of cancer care. The Postal Code Conversion File Plus uses data from Statistics Canada 2011 census to determine population size and income quintiles. Baseline characteristics and chemotherapy treatments were collected retrospectively. Univariate analysis using the Chi-squared test and Fisher’s exact test were used for analysis.
4c3880bb027f159e801041b1021e88e8 Result
1113 patients were included with median age of 69 years, 54% female and 77% were former/current smoker and 47% received palliative chemotherapy. Uptake of chemotherapy did not differ between lowest + mid-lowest 44%, middle 51% /mid-highest + highest 49% income quintiles (p=0.18). Chemotherapy use was also similar between patients reporting financial concerns 50% versus none 47% (p=0.51). Uptake of chemotherapy was lower in patients who lived in rural communities population<10 37% (P 0.00), 10K-1.5M 41%, >1.5 million 53% (p<0.001). Chemotherapy use was lower for patients with concerns about getting to appointments (39% vs 49%, p=0.008) or accommodations (33% vs 48%, p=0.012).
8eea62084ca7e541d918e823422bd82e Conclusion
This dataset provide evidence that patients from rural communities were less likely to receive palliative chemotherapy treatment for metastatic NSCLC in BC despite the availability of multiple local community oncology services. SES did not appear to impact the proportion of patients treated, congruent with a government funded health care system. An in depth assessment of distances to local cancer services and treatment delivery is warranted to investigate these differences and their effect on mortality.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MS26 - From Textbook to Practice Around the World (ID 804)
- Event: WCLC 2018
- Type: Mini Symposium
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 10:30 - 12:00, Room 205 AC
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MS26.02 - Translation of Clinical Data to Real World - North America (ID 11512)
10:45 - 11:00 | Presenting Author(s): Cheryl Ho
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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OA09 - Prevention and Cessation (ID 909)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD
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OA09.07 - Association Between Outdoor Air Pollution And Lung Cancer in Female Never Smokers (ID 14485)
16:20 - 16:30 | Author(s): Cheryl Ho
- Abstract
- Presentation
Background
Long term exposure to ambient particulate matter (PM2.5) has been associated with an increased risk of developing lung cancer, and is estimated to be responsible for ~23% of global lung cancer deaths. No current lung cancer screening risk prediction model uses air pollution as an individual risk factor in its risk calculation. As smoking rates decrease globally, and air pollution increases, it is important to assess the effect of long term outdoor air pollution exposure on lung cancer risk especially in never smokers.
a9ded1e5ce5d75814730bb4caaf49419 Method
We enrolled 421 patients with newly diagnosed lung cancer presenting to BC Cancer and conducted a detailed residential history from birth to estimate their air pollution exposure since 1996 when accurate high-resolution concentration estimates of PM2.5 particulate matter derived from satellite observations and ground measurements became available. The average PM2.5 exposure was quantified by combining residential histories with exposure data.
4c3880bb027f159e801041b1021e88e8 Result
The demographics of the 262(62%) ever smokers, and 159(38%) never smokers with lung cancer are shown in Table 1. Median exposure of all cancer patients was 7.1 PM2.5 ug/m3 (IQR 6.8-7.3; Range 4.3-65.8). Of the ever smokers, 6.1% had a PM2.5 >10 ug/m3 whereas 15.1% of the never smokers had a PM2.5 >10 ug/m3. Among never smokers with lung cancer with high PM2.5 exposure >10 ug/m3, 74% were female and 83% were of Asian descent. Using a logistic regression model, we demonstrated a significant association between air pollution exposure and never smokers compared to ever smokers in women: Odds Ratioper_1_LN-transformed unit = 12.05 (p<0.001). This association was absent in males (interaction p=0.006).
8eea62084ca7e541d918e823422bd82e Conclusion
6f8b794f3246b0c1e1780bb4d4d5dc53
In women with lung cancer, outdoor air pollution exposure was significantly higher in never smokers than in ever smokers. This association was not observed in men with lung cancer.Information from this presentation has been removed upon request of the author.
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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.17-23 - Optimal Therapy of Stage III NSCLC: The Role of Surgery in the Era of Immunotherapy (ID 12537)
16:45 - 18:00 | Author(s): Cheryl Ho
- Abstract
Background
Curative intent treatment of stage III NSCLC may include surgery, radiotherapy, chemotherapy, or combination therapy. Management is influenced by both patient and disease characteristics. N2 disease is optimally treated with concurrent chemoradiotherapy (CRT) and the role of surgery after CRT remains a subject of debate. The recent PACIFIC study of adjuvant durvalumab after CRT in stage III showed unprecedented improvements in relapse free survival, which further calls into question the role of surgery. We sought to perform a real-world analysis of curative therapies in stage III NSCLC, and explore the impact of known prognostic factors on outcome.
a9ded1e5ce5d75814730bb4caaf49419 Method
A retrospective review was completed of all patients referred to BC Cancer from 2005-2012 with stage III NSCLC treated with curative intent including surgery, radiotherapy, chemoradiotherapy, and combined surgery and radiation +/- chemotherapy (S+RT+/-C). Information was collected on known prognostic factors. The primary outcome measure was overall survival.
4c3880bb027f159e801041b1021e88e8 Result
688 patients were included in the study. Baseline characteristics: female 47%, median age 65, ECOG 0-1 65%, weight loss <5% 74%, stage IIIA/IIIB 73%/27%. Treatment: 82 (12%) surgery, 127 (18%) radiotherapy, 423 (62%) chemoradiotherapy, and 56 (8%) combined S+RT+/-C. Median overall survival: surgery 28.6m, chemoradiotherapy 27.6m, radiotherapy alone 18.0m, and S+RT+/-C 55.9m. In a multivariate model incorporating age, sex, weight loss, ECOG, and stage, the survival difference disappeared between the surgery, chemoradiotherapy, and radiotherapy cohorts and persisted in the S+RT+/-C cohort.
Table 1: Univariate and multivariate analysis of the impact of prognostic factors and treatment cohort on survival Variable UVA MVA HR p-value HR 95% CI p-value Treatment Surgery
Radiotherapy
Chemoradiotherapy
S+RT+/-C
Ref
1.669
0.993
0.475
0.001
0.625
0.001
Ref
1.241
0.912
0.523
0.873-1.764
0.675-1.234
0.330-0.830
0.229
0.552
0.006
Age 1.018 <0.001 1.009 0.999-1.020 0.076 Sex Female
Male
Ref
1.211
0.028
Ref
1.111
0.923-1.338
0.264
Stage IIIA
IIIB
Ref
1.239
0.025
Ref
1.121
0.910-1.381
0.283
ECOG 0-1
>=2
Ref
2.128
<0.001
Ref
1.844
1.468-2.265
<0.001
Weight loss <5%
5-10%
>10%
Ref
1.382
1.557
0.010
0.001
Ref
1.232
1.268
0.959-1.582
0.958-1.678
0.102
0.097
8eea62084ca7e541d918e823422bd82e Conclusion
In stage III NSCLC, the performance of surgery, chemoradiotherapy and radiotherapy alone are comparable after controlling for known prognostic factors. Combined S+RT+/-C appears to provide a significant benefit above other modalities in highly selected patients. The role of surgery post-CRT remains controversial, as immunotherapy demonstrates greater promise for improving outcomes for the diverse group of stage III NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.11-03 - Implementing Lung Cancer Screening in Canada: Evidence on Adherence and Budget Impact from the Pan-Canadian Early Detection Study (ID 13417)
12:00 - 13:30 | Author(s): Cheryl Ho
- Abstract
Background
High-risk lung cancer screening has favourable cost-effectiveness ratios; making it an attractive intervention for lung cancer control. Relatively little is known, however, about the implementation of lung cancer screening in universal health care systems. To address this, we characterize screening adherence rates in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan) and prepare a budget impact analysis for Canada.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively characterized screening adherence to short-term (first-year) and long-term (year-four) annual screening rounds in the PanCan study and explored association with socio-demographic and screening characteristics with logistic regression models and Mann-Whitney rank sum and Chi square likelihood tests. We did a four-year budget impact analysis using published utilization rates for screening-related and incidental healthcare resources, smoking cessation, opportunistic screening and projected market dynamics for entrant treatments in Canada.
4c3880bb027f159e801041b1021e88e8 Result
The PanCan study screened 2537 participants with a baseline LDCT exam; of these, 2254 (88.9%) adhered to the second annual screening exam and 1,762 (69.5%) adhered to the year four exam. After adjusting for lung cancer incidences and other-cause mortality, we found significant associations between self-reported “current smoker” status and lower, second annual scan adherence rates (p<0.05); while variables related to the delivery of the intervention—such as the use of screening autofluorescence bronchoscopy and finding a lung nodule on the baseline LDCT—were significantly associated with greater adherence (p<0.05). Adherence to year-four screening exams was positively associated with age, family history of lung cancer, baseline quality of life and prior screening exam adherence (all p<0.05). Non-adherence was significantly associated with participants who had greater than 100 pack-years of smoking history and a lower level of formal education (p<0.05). Compared to participants who adhered to their scheduled, year-four annual screening exams, non-adherent participants had a higher predicted risk of developing lung cancer at baseline (p<0.05). The budget impact analysis indicates that the incremental program costs for screening an estimated 257, 914 eligible, high-risk, Canadians would be highly favourable compared to selection based on age and smoking history alone. The budget impact was also sensitive to uncertainty around the cost to treat actionable incidental findings and the adoption of entrant systemic therapy drugs.
8eea62084ca7e541d918e823422bd82e Conclusion
Study participants who were at the highest risk of developing lung cancer, were the least likely to adhere to screening. Using risk selection would enable affordable programs; however, programs may be compromised by barriers to participation for individuals who are at the greatest risk of developing lung cancer.
6f8b794f3246b0c1e1780bb4d4d5dc53
