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Richard Hubbard
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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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MA18.11 - Implementing a Comprehensive National Audit of Lung Cancer Surgery: The English Lung Cancer Clinical Outcomes Publication (LCCOP) Project (ID 12090)
14:35 - 14:40 | Author(s): Richard Hubbard
- Abstract
- Presentation
Background
We report the establishment of a national audit of outcomes after lung cancer resection (LCCOP) in the English National Health Service (NHS), a government healthcare system providing the great majority of lung cancer surgery. LCCOP is a compulsory audit commissioned by NHS England.
a9ded1e5ce5d75814730bb4caaf49419 Method
Unusually, for a surgical audit, data is initially obtained from the cancer registry, and matched to national Hospital Episode Data (HES), before local validation by clinical teams. After case mix adjustment, unit level survival rates at 30, 60 and 90 days, and length-of-stay data are published online and in an annual report. The first annual report was released in 2014.
Survival is adjusted for age, sex, performance status, stage, laterality, FEV1 percentage, comorbidity and socioeconomic status
4c3880bb027f159e801041b1021e88e8 Result
The number of resections rose by 21% between 2015-2017 (4892 to 5936). Median annual activity per surgeon rose from 30 to 49 cases between 2014-2017, a 63% increase. In 2015 survival at 30, 90 and 365 days was 98.1%, 96.3% and 87.9% respectively. Median length of stay was 6 days (IQR 4-9).
In 2015, 43.9% of lobectomies were completed by VATS, 4.3% were started VATS and completed by open surgery and 0.7% completed by robotics.
Adjusted 90 day survival by surgical unit: 2017 report (2015 data)
8eea62084ca7e541d918e823422bd82e Conclusion
Using routinely collected NHS activity data for surgical audit is feasible, and reduces the data collection burden for hospital teams. Clinical validation remains important to correct discrepancies. Surgical activity has risen significantly. Increases in individual surgeon case volume may reflect increasing subspecialisation. Significant inter-provider variation remains, particularly in length of stay.
More lung cancer surgery is being done in the English NHS. Surgeons are increasingly subspecialising, with higher case volumes. Local variation remains, particularly around length of stay. A mixed model of routinely collected data with local validation appears acceptable to clinical units.
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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P1.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 944)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.12-12 - A Systematic Review and Meta-Analysis of Early and Late Survival Following Anti-Cancer Therapies for Small Cell Lung Cancer (ID 13476)
16:45 - 18:00 | Author(s): Richard Hubbard
- Abstract
Background
Treatments for small cell lung cancer (SCLC) have not changed significantly in contrast to non-small cell where it is more individually tailored. Current guidelines generally have a one size fits all approach to chemotherapy. We conducted the largest systematic review and meta-analysis in SCLC to evaluate early and median survival by different study factors.
a9ded1e5ce5d75814730bb4caaf49419 Method
We searched EMBASE and MEDLINE for randomized controlled trials and observational cohort studies which reported survival following platinum doublet chemotherapy for SCLC. We calculated overall survival at 30 and 90 days along with the median survival.
4c3880bb027f159e801041b1021e88e8 Result
We identified 10,487 titles, 161 were included. Cisplatin + etoposide (n=87 (49.4%)), carboplatin + etoposide (n=36 (20.5%)) and cisplatin + irinotecan (n=23 (13.1%)) were predominantly reported. The commonly reported cause of death within 30 days was neutropaenic sepsis (n=27), disease progression (n=11) and cardiovascular (n=8). Across both stages 30-day survival was 98% (95% CI 98-99%) whilst 90-day was 95% (95% CI 94-96%). Thirty and 90-day survival showed similar patterns to study factors as median survival (summarised in Table 1).
Limited stage median survival was 18.1 months (95% CI 17.0-19.1). Studies that administered thoracic radiotherapy and PCI had better survival than those that did not. Studies giving carboplatin + etoposide or included poorer PS (0-3) individuals had inferior survival. PCI timing did not show survival differences.
Extensive stage median survival was 9.6 months (95% CI 8.9-10.3). This was augmented in studies that gave irinotecan + cisplatin and were conducted in Asia. There were no survival differences by cisplatin/carboplatin or median participant age.
8eea62084ca7e541d918e823422bd82e Conclusion
Neutropenic sepsis accounts for the majority of 30-day deaths and was mostly reported with cisplatin + etoposide. Our findings broadly support guideline recommendations but suggest certain sub-populations e.g. Asian individuals, benefit from targeted treatment with irinotecan + cisplatin. Age should be re-considered as a treatment-deciding factor in extensive stage.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)
- 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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P2.16-21 - Post-Treatment Survival Difference Between Lobectomy and Stereotactic Ablative Radiotherapy in Stage 1 Non-Small Cell Lung Cancer in England (ID 12349)
16:45 - 18:00 | Author(s): Richard Hubbard
- Abstract
Background
Non-small cell lung cancer (NSCLC) accounts for almost 85% of all lung cancer cases diagnosed in England. Stage 1 lung cancer represents around 15-20% of all NSCLC cases, and while surgical resection (the current standard of care) offers the best chance to improve survival and is the standard of care in early lung cancer, not all patients undergo surgical treatment due to their advanced age and/or multiple comorbidities, while others may refuse surgery. Stereotactic ablative radiotherapy (SABR), a non-invasive external beam radiotherapy, has become an established treatment option for such patients. The aim was to compare survival at 90 days, 6 months, one year and overall for patients who received either lobectomy or SABR for NSCLC stage IA and IB.
a9ded1e5ce5d75814730bb4caaf49419 Method
We used data from the 2015 National Lung Cancer Audit (NLCA) database that were collected by Public Health England (PHE) and linked with Hospital Episode Statistics (HES) and the Radiotherapy Dataset (RTDS) to identify patients with NSCLC stage IA-IB and performance status 0-2 who underwent surgery or SABR treatment. We looked at survival risk difference at 90 days, 6 months, 1 year and 1 year between the two patient groups using propensity score derived using a logistic regression model with covariates that were predictive of treatment including age, sex, performance status and stage.
4c3880bb027f159e801041b1021e88e8 Result
We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening performance status were associated with having SABR rather than surgery. Patients who had SABR had 1.4% better survival at 90-days; however, this survival benefit dropped at 6 months after treatment started and patients who had surgery had 14% better overall survival.
8eea62084ca7e541d918e823422bd82e Conclusion
Our analysis suggests that, while patients who underwent SABR have better short-term survival, patients who have surgery have better overall survival. However, the time to the start of treatment with SABR was 8 weeks longer than for surgery. Thus early survival may be underestimated for SABR although other (conflicting) factors may be at play including stage-shift (more in SABR group) and length time (potentially more indolent tumours in the SABR group).
6f8b794f3246b0c1e1780bb4d4d5dc53
