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Leah Backhus



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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: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.15-06 - Examination of Optimal Timing of Post-Surgical Surveillance for Early Stage Lung Cancer Patients and Association with Outcomes (ID 13119)

      16:45 - 18:00  |  Presenting Author(s): Leah Backhus

      • Abstract

      Background

      Guidelines for post-operative surveillance for NSCLC are variable. Historically, surgeons have used a one-size fits all approach, such that surveillance guidelines incorporate few important prognostic indicators for recurrence and survival. Recent NCCN guidelines recommend surveillance CT every 6 months for both stage I and II patients. This is in contrast to the recent IFCT-0302 Trial suggesting that CT scans every 6 months are not useful within the first 2 years following surgery. The goal of this study was to determine optimal timing for detection of recurrence by CT scan and the association between surveillance CT and overall survival.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This was a retrospective, single institution series of patients undergoing surgical resection (2008-2012) with stage I or II disease (AJCC 7thedition) with at least 6 months of follow-up. Guideline adherence was defined as receipt of CT every 6 months for the first two years and annually thereafter.

      4c3880bb027f159e801041b1021e88e8 Result

      The cohort consisted of 162 patients (80% stage I 20% stage II) with median follow-up 57 months. Recurrence occurred in 27.5% of patients at a median of 29.5 months following surgery. The rate of adherence to guideline recommended surveillance ranged 61%-76.3%with the majority of all CT scans done for surveillance purposes (87%-98%). The percentage of CT scans with suspicious findings was relatively stable over time (30-35%), however, the rate of CT scans with recurrence was variable, peaking at 2-3 years following surgery. For those detected on CT scan, stage I recurrences peaked at 25-36 months whereas stage II peaked at 19-24 months.

      Timing of recurrences differed significantly based on stage with 81% of recurrences occurring > 24 months following surgery for Stage I patients compared to 41% of a Stage II patients. (p<0.01) Overall, higher rates of surveillance CT were associated with a reduced risk of death (HR 0.14 [95% CI 0.06-0.36] p<0.01).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The majority of CT imaging performed within 5 years following surgery was done for surveillance purposes rather than symptoms. The timing of recurrence differs significantly based on stage such that few stage I patients have recurrences within 2 years following surgical resection. Additionally, rates of recurrence detected by surveillance CT scans performed less than 24 months following surgery is lower for stage I patients.These results should be examined within a larger cohort with longer longitudinal follow-up as timing of CT surveillance based on peak recurrence rates has the potential to eliminate unnecessary testing and expense for healthcare systems.

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      P2.15-21 - Post Resection Lung Cancer Surveillance: Comparisons of Practice Between STS, ESTS and JACS Members (ID 12202)

      16:45 - 18:00  |  Author(s): Leah Backhus

      • Abstract
      • Slides

      Background

      We recently investigated contemporary practice in post-resection lung cancer surveillance, between the Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgeons (ESTS) updating a published STS survey and showed a wide variance of practice.

      In order to understand better the role of socio-demographics on this divergence, we aim to compare these patterns to those of members of the Japanese Association for Chest Surgery(JACS) as well as surveillance attitudes across these regions.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A survey identical to the one conducted in 1995 among STS members was administered via mail or electronically to members of the STS, ESTS and JACS requesting responses from those treating NSCLC. Goodness of fit tests were used to compare profiles of respondents and attitudes toward testing between groups. Multivariable logistic regression was performed to examine for predictors of guideline concordant surveillance with CT.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 2978 STS member (response rate 7.8%, n=234), 1450 ESTS members (response rate 8.4%, n=122) and 272 JACS (response rate 40,8%, n=111) members were surveyed. All three societies reported similar use of history and physical examination for asymptomatic patients (75%vs78%vs73%p=0.52). Rate of guideline-recommended surveillance CT was reported highest among ESTS respondents for stage I patients (22% ESTS, 3% STS and 6% JACS members, p<0.01). However, both JACS and ESTS respondents reported higher rates of use of non-guidelines-recommended tests compared to STS respondents which persisted on adjusted analyses. In particular, JACS and ESTS respondents reported significantly higher use of brain MRI (JACS AOR 13.85 [7.46-25.73] ESTS AOR 2.81 [1.59-4.99], p<0.01), Bone Scan (ESTS AOR 3.00 [1.68-5.36] JACS AOR 5.69 [3.21-10.08], p<0.01) and bronchoscopy for post-resection surveillance (JACS AOR 3.51 [1.99-6.20] ESTS AOR 3.25 [1.83-5.79], p<0.01) compared to STS respondents. Regarding attitudes towards surveillance, more JACS and ESTS members either “agree” or “strongly agree” that routine testing for NSCLC recurrence results in potentially curative treatment (ESTS:86%, STS:70%, JACS:90% p<0.01). Similarly, JACS and ESTS respondents believe that surveillance would identify a curable second primary NSCLC (ESTS:94%, STS:84%, JACS:100% p<0.01) and that current literature documents definitive survival benefits from routine follow-up testing (ESTS:57%, STS:30%, JACS:62% p<0.01).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The Japanese attitude towards surveillance is similar to that of ESTS members potentially highlighting significant differences between European and Asian surgeons compared to STS members and may be the underpinnings of routine use of non-guideline concordant surveillance. These differences clearly highlight the need of better prospective studies and joint recommendations to standardize practice globally.

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