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Donna E Maziak



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    P1.05 - Interventional Diagnostics/Pulmonology (Not CME Accredited Session) (ID 937)

    • 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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      P1.05-03 - Significance of Lymph Node SUVmax In Predicting Nodal Metastasis By EBUS in Lung Cancer Patients (ID 12043)

      16:45 - 18:00  |  Author(s): Donna E Maziak

      • Abstract
      • Slides

      Background

      Nodal staging of non-small-cell lung cancer (NSCLC) patients begins with imaging such as Positron emission tomography–computed tomography (PET-CT). It provides information about lymph node (LN) location, enlargement, and metabolic activity as measured by the maximum standardized uptake value (SUVmax). However, more definitive information can only be obtained by direct sampling through cervical mediastinoscopy (Med) and/or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS). There remains discrepancy when comparing the diagnostic accuracy of these two methods for detecting nodal metastasis. Further, there is inadequate data on the value of SUVmax magnitude in predicting nodal metastasis by EBUS.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This was a retrospective analysis of 148 biopsy-confirmed NSCLC patients who underwent Med and/or EBUS for staging purposes from 2010-2015 (2013 excluded). Two groups matched by age, sex, and year of procedure were analyzed to determine if the diagnostic accuracy was comparable between the two methods. Primary tumour and LN SUVmax was correlated with the likelihood of finding LN metastasis by either method. Chi-squared tests and Student's t-tests were used to assess for significance where appropriate.

      4c3880bb027f159e801041b1021e88e8 Result

      The mean SUVmax of true positive LNs was significantly higher than true negative LNs sampled by EBUS (7.77 vs. 4.06, p=0.0047, t-test). Among PET-positive LNs, there was a significant correlation between likelihood of positive findings by EBUS and increased SUVmax>4 (p=0.018, Chi-squared test). There were no significant differences between Med and EBUS in sensitivity, specificity, PPV, or NPV. However, Med had significantly higher diagnostic yield (p<0.0001, Chi-squared test).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our results suggest that among PET-positive LNs, there is a significant correlation between SUVmax magnitude and likelihood of detecting true LN metastasis by EBUS. Additional studies should aim to further characterize this relationship.

      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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      P2.16-50 - Do Patients Have Preconceived Ideas on Various Surgical Approaches? Patient Perspective: Open vs. Minimally Invasive Surgery (PROMIS) Survey. (ID 14398)

      16:45 - 18:00  |  Author(s): Donna E Maziak

      • Abstract
      • Slides

      Background

      Patient perspectives on minimally invasive (MIS) versus open surgical approaches have not been well studied. Health care workers often presume that patients prefer MIS. The aim of this survey was to objectively document patient viewpoints on pain, complication risks, cosmesis, travel burden, and functional outcomes throughout the course of treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 2012-2017, of the 206 consented patients, 184 lung and esophageal surgical patients were prospectively enrolled in this observational cohort study. Participants were asked to complete a RAND36 short form health survey (SF-36), which measures functional outcomes. They also completed the PROMIS questionnaire, which measures expectations regarding travel burden, pain, complications, and cosmesis on a continuous visual analog scale (VAS). The PROMIS questions were also classified into three anatomic regions (neck, chest, and abdomen). Patients were surveyed pre-operatively, at 1 month and at 6 months. McNemar’s test, and paired and independent t-test were used as appropriate.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 206 patients, 184 (89%) completed the survey at least once. SF-36 showed physical functioning, role limitations due to physical health, energy level, pain, and social functioning worsened significantly at 1 month. All indices recovered to baseline at 6 months. Recovery of indices was similar in both MIS and open surgery patients. Patients indicated that pain after surgery (mean VAS = 7.3; 95% CI 6.9-7.6) was more important than size of incision (mean VAS = 4.5; 95% CI 3.9-5.1, p < 0.001) and travel burden (mean VAS = 4.0; 95% CI 3.4-4.5, p < 0.001). The risk of complications (mean VAS = 7.5; 95% CI 7.2-7.9) was more important than size of incision (mean VAS = 4.5; 95% CI 3.9-5.1, p < 0.001) and travel burden (mean VAS = 4.0; 95% CI 3.4-4.5, p < 0.001). These findings were similar at each time point and across each body regions. The MIS group perceived pain following surgery (mean VAS = 7.12; 95% CI 6.35-7.89) was more important than the open group though it was not statistically different (mean VAS = 6.02; 95% CI 5.25-6.79, p = 0.07).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early postoperative deterioration followed by 6-month recovery in functional outcomes was reported by all patients regardless of surgical approach (MIS vs. open). Complication risk and pain after surgery were perceived as more important than size of incisions and distance traveled for treatment. Patients maybe more open-minded to participation in trials comparing MIS to open surgery than expected.

      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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      P3.11-11 - Improving Timeliness of Lung Cancer Diagnostic Services with the Implementation of Coordinated Care via a “Navigation Day” (ID 12445)

      12:00 - 13:30  |  Author(s): Donna E Maziak

      • Abstract
      • Slides

      Background

      Lung cancer patients often experience stressful wait times and delays throughout the diagnostic phase of care. In an effort to streamline this process, a multidisciplinary team at The Ottawa Hospital (TOH) created a “Navigation Day” whereby patients and their family partake in a day-long visit and receive concurrent coordinated testing. At the Navigation Day, patients have teaching, introduction to social work, access to specialist care for symptom control, and same day appointments via dedicated test slots for positron emission tomography–computed tomography (PET-CT) scans, pulmonary function tests (PFTs) and/or magnetic resonance imaging (MRI) of the head. We evaluated the impact of this program on wait times and patient satisfaction.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients with a suspicion of lung cancer on chest CT who were referred during three time periods relative to the implementation of Navigation Day were included: one year pre-launch, one year post-launch, and two years post-launch. Mean wait times for PET, PFT, and/or MRI tests were calculated for each time period. To specifically assess the impact of dedicated slots on wait times, patients within each time period were stratified according to whether they underwent their test on the same day or different day from their Navigation Day. Student’s t-test and ANOVA were used to assess for significance. Patient satisfaction was measured by examining provincially-collected data from a standardized survey used by all diagnostic assessment programs in Ontario, and data from program-specific feedback surveys distributed at TOH.

      4c3880bb027f159e801041b1021e88e8 Result

      At one year post-launch, mean wait times improved from 15.5 to 9.2 days for PET (p<0.0001, t-test), from 15.7 to 9.6 days for PFT (p<0.0001), and from 16.0 to 10.2 days for MRI (p<0.0001). These improvements were sustained at two years post-launch, and MRI wait time improved even further from 10.2 to 6.6 days (p<0.0001, t-test). Those patients who underwent tests within a dedicated slot experienced the shortest wait times for all tests, at 5.8 days for PET, 5.8 days for PFT, and 6.3 days for MRI (p<0.0001, ANOVA). Wait time dispersion also improved by 11.2% for PET, 10.1% for PFT, and 19.1% for MRI. Patient satisfaction in the categories of quality of care, rapidity of care, coordination of care, and being informed remained high following the implementation of Navigation Day.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Implementation of a Navigation Day significantly improved timeliness of diagnostic services (PET, PFT, and MRI) for potential lung cancer patients. This program represents an innovative service delivery model for other lung cancer care centers.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active 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 or select "Add to Cart" and proceed to checkout.