Author of

• 25908

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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

  • 26096

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    MA18.06 - Patterns of Lung Cancer Care in the United States: Developments and Disparities (ID 11991)

    14:00 - 14:05  |  Presenting Author(s): Erik Ferdinand Blom
    • Abstract
    • Presentation
    • Slides

    Background
    

    The level of adherence to lung cancer treatment guidelines is unclear. The aims of this current study were to provide an overview of current patterns of lung cancer care in the United States and to identify possible disparities in receiving standard of care.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Using the National Cancer Database, we evaluated the first course therapy of 468,422 lung cancer cases diagnosed between 2010-2014. We used a series of multivariate logistic regression models to identify relationships between patient, tumor, and health care provider characteristics and receiving predefined stage-specific standards of care.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Most common treatments were surgery only (15.2%), radiotherapy only (12.8%), chemotherapy only (13.5%), and radiotherapy and chemotherapy (26.2%). 22.1% of subjects received no treatment. Between 2010-2014, the use of Video-Assisted Thoracoscopic Surgery among surgically treated cases increased from 24.6% to 42.3%, while the rate of conversions to open surgery decreased from 18.3% to 10.4%. Among stage IA non-small cell lung cancer patients treated with thoracic radiotherapy, the use of Stereotactic Body Radiotherapy increased from 53.4% to 73.0%. Overall, only 63.3% of subjects received standard of care. Receiving surgery for early-stage non-small cell lung cancer was less likely with increasing age (for those 80 and over: odds ratio [OR], 0.08; 95% confidence interval [95%CI], 0.07-0.09), for non-Hispanic Blacks (OR, 0.59; 95%CI, 0.57-0.62), and for squamous cell histology (OR, 0.46; 95%CI, 0.45-0.47). These disparities were also present in other stages.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Particularly elderly lung cancer patients, non-Hispanic Blacks, and those with squamous cell histology are less likely to receive standard of care. These disparities may have consequences for lung cancer screening, as the effectiveness depends on adequate treatment of lung cancer.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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• 25948

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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

  • 27126

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    P2.11-04 - Treatment Capacity Required for Implementing Lung Cancer Screening in the United States (ID 13825)

    16:45 - 18:00  |  Presenting Author(s): Erik Ferdinand Blom
    • Abstract
    • Slides

    Background
    

    Implementing Low-Dose Computed Tomography screening for lung cancer will lead to an increased detection of early stages. The required resources to treat those cancers remains unknown.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We extended a well-established microsimulation model with data from the National Cancer Database to assess the number of lung cancer patients requiring surgery, radiotherapy, chemotherapy, and no therapy when implementing lung cancer screening in the United States in 2018. Three screening policies were assessed: the United States Preventive Task Force (USPSTF) recommendations; the Centers for Medicare & Medicaid Services (CMS) recommendations; and the most cost-effective policy from a study for Cancer Care Ontario (annual screening, ages 55-75, at least 40-pack year smoking history, currently smoking or quit within last 10 years). Base-case screening adherence was 50%. Sensitivity analyses assessed 20%, 35%, 65% and 80% adherence.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Implementing the USPSTF recommendations with 50% screening adherence would require 35.3% more lung cancer surgeries in 2015-2040 compared to no screening. However, 2.1% less radiotherapy and 5.1% less chemotherapy treatments would be required. Furthermore, 6.2% fewer patients would receive no therapy. The required number of lung cancer surgeries would be 75,379 in 2018, 58,155 in 2023, 55,269 in 2028, and 45,007 in 2040. Compared to no screening, this is an increase of 92.7% in 2018, 44.3% in 2023, 36.8% in 2028, and 23.0% in 2040. Screening adherence strongly influenced results. By 2018, the required number of surgeries would range from 53,666 (with 20% adherence) to 96,953 (with 80% adherence). Results for the CMS and Ontario policies were similar to the USPSTF policy, although changes compared to no screening were smaller.

    

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Implementing lung cancer screening in the United States requires a major increase in surgical capacity. The current workforce of thoracic surgeons in the United States may not be able to cope with this increased demand.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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