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Stephane Beaudoin



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    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • 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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      P2.06-33 - Heterogeneity in Care Pathways for Patients with Malignant Pleural Mesothelioma Presenting at a Quaternary Thoracic Oncology Center in Quebec (ID 14346)

      16:45 - 18:00  |  Author(s): Stephane Beaudoin

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma (MPM) is a rare disease for which diagnostic and therapeutic trajectories are ill-defined. We hypothesize that MPM patients experience delays during their diagnostic and therapeutic trajectory with significant heterogeneity in care pathways. Thus, we evaluated management practices at the MUHC over the past 10 years to address the need for a centralized program and dedicated care team.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a retrospective chart review of MPM cases diagnosed at our center from 2006 to 2016. Clinical, pathologic, and treatment variables were collected. We assessed time from first abnormal imaging to definitive diagnosis, time from definitive diagnosis to first treatment and time from definitive diagnosis to palliative care consult. Overall survival was analyzed by Kaplan Meir method.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 145 patients over a 10-year period and report outcomes on 92 cases with complete data. Demographic data are presented in Table 1. Overall survival was 1.4% at 5-years for all patients, with a median survival of 1 year following a definitive diagnosis. Forty-five percent of patients underwent an investigational PET/CT scan, 89% of patients had M0 status prior to treatment, of whom 20% developed extra-thoracic metastases. Sixty-three percent of patients received some form of treatment. Eight treatment combinations were identified, irrespective of intent, lymph node involvement, and metastatic status. With regards to delays in care pathway, median time from first abnormal imaging to definitive diagnosis was 34 days (IQR 20.5 to 55), definitive diagnosis to first therapeutic intervention was65 days (IQR 35.8 to 163.8), and definitive diagnosis to palliative consult was 289 days (IQR 3 to 1651).

      Table 1. Demographics and treatment characteristics of patients diagnosed with MPM at the McGill University Health Center over a 10-year period.
      Characteristics Overall
      Sample size 92
      Age Number (%)
      Median (IQR) 72 (62-79.5)
      Female Gender, n (%) 19 (20.7)
      Previous or current smoker, n (%) 36 (39.1)
      Asbestos Exposure
      No 20 (21.7)
      Yes 36 (39.1)
      Unknown 36 (39.1)
      Type of MPM
      Biphasic 9 (9.8)
      Desmoplastic 3 (3.3)
      Epitheliod 67 (72.8)
      Sarcomatoid 3 (3.3)
      Not otherwise specified 10 (10.9)
      Treatment
      No 28 (30.4)
      Yes 58 (63.0)
      Unknown 6 (6.5)
      Treatment Course
      Chemotherapy only 8 (13.8)
      Chemo & Radiotherapy 5 (8.6)
      Radiotherapy only 15 (25.9)
      Surgery only 10 (17.2)
      Trimodality therapy 7 (12.1)
      Surgery and Chemo 7 (12.1)
      Surgery and Radiotherapy 4 (6.9)
      Concurrent therapy 2 (3.4)
      Intent at first treatment
      Curative 31 (53.4)
      Palliative 24 (41.4)
      Unknown 3 (5.2)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Overall outcomes for MPM patients presenting at our center are equivalent to historical controls. However, significant heterogeneity and delays exist during the patient trajectory. A centralized approach to diagnosis and treatment may lead to a more efficient and beneficial trajectory for these patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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