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Greg R Pond
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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
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P2.11-23 - Risk Perception Among a Lung Cancer Screening Population (ID 13045)
16:45 - 18:00 | Author(s): Greg R Pond
- Abstract
Background
To make lung cancer screening feasible, populations with the highest risk of developing cancer need to be targeted. Furthermore, factors which motivate individuals to participate in lung cancer screening programs should be integrated into recruitment strategies. Among these motivators, an individual’s perception of their lung cancer risk is an important consideration. This paper analyzes factors associated with risk perception in subjects enrolled in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), and assesses the relationship between subjects’ risk perception and actual calculated risk.
a9ded1e5ce5d75814730bb4caaf49419 Method
The PanCan low-dose screening CT study recruited individuals from the general population who were current or former smokers age 50-75 having at least a 2% risk of developing lung cancer over 6 years as calculated by the PanCan model. Risk perception was captured at baseline with a 5-point Likert scale question asking the subject to assess their personal chances of being diagnosed with lung cancer compared with other smokers of the same age. Multivariate linear regression analysis was used to assess the relationship between risk factors and risk perception. Baseline risk variables in the model include demographics, smoking history, symptoms, medications, occupation, previous chest imaging, history of COPD, medical comorbidities, and family history of cancer.
4c3880bb027f159e801041b1021e88e8 Result
2514 patients were included in the analysis. Median age was 62.3, 55.3% were male, median pack-year smoking history was 50 years (range 2.2-230), and median calculated lung cancer risk was 3.4% over 6 years (range 2-38.2). Calculated lung cancer risk increased by 0.08% (SE 0.02, p-value=0.001) for each increase in Likert risk perception category. On multivariable analysis, the following variables were associated with risk perception category: cigarettes smoked per day (+0.003 increase in category / cigarette, p=0.083), presence of dyspnea (+0.192), presence of wheeze (+0.272), known COPD (+0.110), no family history of cancer (-0.476) and no family history of lung cancer (-0.385) (all p<0.001). Increased perception of risk was associated with intent to quit smoking within 6 months (p<0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
In this lung cancer screening study, risk perception was positively associated with calculated risk for lung cancer, despite a minimum 2% risk in the cohort. Individual factors and family history of cancer predicted risk perception. Risk perception was also associated with a willingness to quit smoking. Self-risk perception and associated factors could be used to tailor recruitment strategies to screening programs. The link between risk perception and willingness to quit smoking could aid integrated tobacco cessation programs.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- 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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P2.15-31 - The Evolution of Costs in the Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC) in Ontario, Canada Between 1999 to 2014 (ID 13480)
16:45 - 18:00 | Author(s): Greg R Pond
- Abstract
Background
Treatment options for patients with advanced non-small cell lung cancer (NSCLC) have evolved substantially since the 1990s. Newer agents are more expensive to acquire and administer and the perception is the cost of lung cancer care has increased considerably in the last two decades. We conducted a cost analysis study to evaluate changes in the total cost of NSCLC care over time.
a9ded1e5ce5d75814730bb4caaf49419 Method
We conducted a retrospective cohort study of all NSCLC patients diagnosed in Ontario from Apr 1, 1999 to Mar 30, 2014, who received palliative chemotherapy for advanced disease. Variables of interest were extracted from provincial registry data electronically linked by the Institute for Clinical Evaluative Sciences (ICES). The use of oral systemic therapy is not universally captured in these databases. The mean total cost of care including, systemic therapy, and supportive care (hospitalizations, physician billings, lab tests, out-patient visits, emergency visits, home care, and most prescription medications), was calculated in 2015 CAD dollars by fiscal year of diagnosis. Regression analysis was used to project costs in years with missing supportive care costs.
4c3880bb027f159e801041b1021e88e8 Result
Of all NSCLC cases diagnosed in Ontario (n=89,936), 21.6% (n=19,447) received any chemotherapy for advanced disease. In this population, median age ranged from 65 to 69 years, 54.9% were male, 15.4% resided rurally, 45.0% were adenocarcinoma, 58.6% with de novo stage IV disease, and 25.8% received second line chemotherapy. At the time of the data analysis, 6.8% of patients are presumed to be alive.
The average cost of care per patient treated rose from $85,339 to $102,026. The cost of systemic therapy rose from $3,856 to $12,554. During the same time period, average supportive care costs changed from $84,732 to $93,495. The proportion of total costs of systemic therapy changed from 4.5% to 12.3%. Utilization of palliative chemotherapy in only those with de novo stage IV disease remained stable over time (29.8%).
Patients who received second line chemotherapy cost 5.9 times that of patients who did not ($11,342 and $1,924 respectively). Costs in the final year of life increased from 61.9% to 68.0% of total lifetime costs from 2003 to 2014.
8eea62084ca7e541d918e823422bd82e Conclusion
The cost of systemic therapy for lung cancer patients is rising disproportionately to that of supportive care. Ongoing analyses are assessing the main drivers of cost of care and model the impact of oral targeted therapies and immunotherapies on the cost of lung cancer care.
6f8b794f3246b0c1e1780bb4d4d5dc53
