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John R Goffin
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MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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MA18.03 - How in the Real World Are Lung Cancer Patients Treated? The Ontario, Canada Experience (ID 13772)
13:35 - 13:40 | Author(s): John R Goffin
- Abstract
- Presentation
Background
Clinical trials define treatment recommendations but how patients are actually treated in the real world is poorly understood. The Canadian Partnership Against Cancer has developed a model of lung cancer (LC) management (OncoSim-lung) based on clinical trials data and expert advice. To credibly project the future clinical and economic impacts of cancer control measures using OncoSim, the model has been refined using real-world data.
a9ded1e5ce5d75814730bb4caaf49419 Method
Treatment data by histology and stage were extracted from the Ontario Cancer Registry for LC cohorts diagnosed in 2010 and 2013. All incident cases that satisfied the IARC rule of a new primary were included. Missing or unknown stage cases were excluded. Clinical pathways were validated by oncologists from different disciplines across Canada.
4c3880bb027f159e801041b1021e88e8 Result
The 2013 cohort included 8,086 staged LC: NSCLC (n=7,143) Stage I 18.7%, II 8%, III/IIIa 11.4%, IIIb 4.9% IV 56.8%; SCLC (n= 943) limited 67.7%, extensive 32.3%. Of 1340 stage I NSCLC patients, 61% underwent surgery; 39% had no surgery and one third of these had no active treatment (NAT). 55% of those not receiving surgery underwent radical radiotherapy and 6% had palliative radiotherapy. Of 579 patients with stage II NSCLC, 60% underwent surgery and 47% of these received adjuvant chemotherapy; 40% had no surgery and 22% of these had NAT. Radical radiotherapy, radiotherapy plus chemotherapy or palliative radiotherapy were given in 33%, 19% and 18% of non-surgical cases, respectively. Of 813 stage III/IIIa patients, only 26% underwent surgery, 41% of whom received adjuvant chemotherapy or postoperative radical radiotherapy (16%); 13% received trimodality treatment. Of the 75% of Stage III not receiving surgery, 26% had NAT and 21% had palliative radiotherapy alone. Of those receiving active treatment, 20% received combined chemo +radiotherapy and 13% each had chemotherapy alone or radical radiotherapy alone. Of 356 stage IIIb patients, 17% had NAT, 28% received palliative radiotherapy and only 30% had chemo + radical radiotherapy. 18% had chemo alone. Of 4055 stage IV NSCLC, 47% had NAT, 24% received chemotherapy alone and 23% had palliative radiotherapy only. Of those who received first-line chemotherapy (n= 1059), 47% received second line chemotherapy and of those, 37% received third line therapy.
8eea62084ca7e541d918e823422bd82e Conclusion
Compared to prior expert opinion, there was a higher use of radiotherapy for early stage disease, a lower frequency of chemo-radiotherapy in Stage III disease and a higher frequency of NAT across all stages of disease.
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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MS29 - Selection into Screening Programs: Interplay of Risk Algorithms, Genetic Markers and Biomarkers (ID 807)
- Event: WCLC 2018
- Type: Mini Symposium
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 13:30 - 15:00, Room 206 F
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MS29.00 - Introduction with Poll Slides (ID 14933)
13:30 - 13:35 | Presenting Author(s): John R Goffin
- 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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P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)
- 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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P2.11-23 - Risk Perception Among a Lung Cancer Screening Population (ID 13045)
16:45 - 18:00 | Presenting Author(s): John R Goffin
- Abstract
Background
To make lung cancer screening feasible, populations with the highest risk of developing cancer need to be targeted. Furthermore, factors which motivate individuals to participate in lung cancer screening programs should be integrated into recruitment strategies. Among these motivators, an individual’s perception of their lung cancer risk is an important consideration. This paper analyzes factors associated with risk perception in subjects enrolled in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), and assesses the relationship between subjects’ risk perception and actual calculated risk.
a9ded1e5ce5d75814730bb4caaf49419 Method
The PanCan low-dose screening CT study recruited individuals from the general population who were current or former smokers age 50-75 having at least a 2% risk of developing lung cancer over 6 years as calculated by the PanCan model. Risk perception was captured at baseline with a 5-point Likert scale question asking the subject to assess their personal chances of being diagnosed with lung cancer compared with other smokers of the same age. Multivariate linear regression analysis was used to assess the relationship between risk factors and risk perception. Baseline risk variables in the model include demographics, smoking history, symptoms, medications, occupation, previous chest imaging, history of COPD, medical comorbidities, and family history of cancer.
4c3880bb027f159e801041b1021e88e8 Result
2514 patients were included in the analysis. Median age was 62.3, 55.3% were male, median pack-year smoking history was 50 years (range 2.2-230), and median calculated lung cancer risk was 3.4% over 6 years (range 2-38.2). Calculated lung cancer risk increased by 0.08% (SE 0.02, p-value=0.001) for each increase in Likert risk perception category. On multivariable analysis, the following variables were associated with risk perception category: cigarettes smoked per day (+0.003 increase in category / cigarette, p=0.083), presence of dyspnea (+0.192), presence of wheeze (+0.272), known COPD (+0.110), no family history of cancer (-0.476) and no family history of lung cancer (-0.385) (all p<0.001). Increased perception of risk was associated with intent to quit smoking within 6 months (p<0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
In this lung cancer screening study, risk perception was positively associated with calculated risk for lung cancer, despite a minimum 2% risk in the cohort. Individual factors and family history of cancer predicted risk perception. Risk perception was also associated with a willingness to quit smoking. Self-risk perception and associated factors could be used to tailor recruitment strategies to screening programs. The link between risk perception and willingness to quit smoking could aid integrated tobacco cessation programs.
6f8b794f3246b0c1e1780bb4d4d5dc53
