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Nicole Mittmann

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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): Nicole Mittmann

      • Abstract
      • Presentation
      • Slides


      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.


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