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Cecilia Pompili



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

      16:45 - 18:00  |  Presenting Author(s): Cecilia Pompili

      • 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.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • 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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      P3.16-08 - Baseline Quality of Life is Influenced by the Duration of Abstinence from Smoking in Candidates to Lung Cancer Surgery (ID 12350)

      12:00 - 13:30  |  Presenting Author(s): Cecilia Pompili

      • Abstract
      • Slides

      Background

      The optimal interval of smoking cessation before Non-Small Cell Lung Cancer (NSCLC) surgery is still unknown. The objective of this study is to evaluate the influence of smoking cessation on the preoperative quality of life (QoL) of surgical NSCLC patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      266 consecutive ever smokers (133 females) with a pack year history >=20 undergoing lung resections for NSCLC and with complete preoperative QoL data were analysed. The EORTC QoL summary score was calculated (SumS) as the average of the individual functional and reversed symptom scales (excluding Global-Health and Financial-Impact scales). The following smoking-related variables were tested for a possible association with SumS: age when the patient quit smoking and months elapsed from smoking cessation (for current smokers a value of 0 was used). These variables were entered as independent predictors in a stepwise multivariable regression analysis along with several patient-related baseline factors.

      4c3880bb027f159e801041b1021e88e8 Result

      108 patients were current smokers, 158 were ex smokers (quit at least 1month before surgery). We found no difference of preoperative QoL SumS between current smokers and ex smokers (81.5 vs. 83.0, p=0.66). Amongst the 158 ex-smokers, 69 quit smoking before the age of 60. Their SumS was similar to the one of those who quit older (84.2 vs. 82.0, p=0.30). A linear regression showed a significant association between the duration of abstinence from smoke and their QoL SumS (coefficient 0.02, SE 0.009, p=0.03). When the analysis was adjusted for other confounders using a multivariable regression analysis, the duration of abstinence from smoking (p<0.0001-longer time better QoL)(Fig1) and the age at which the patient quit smoking (p=0.001-older age better QoL)remained independently associated with SumS along with performance score.

      Figure 1: Lowess Curve plotting SumS against the months elapsed from the time quit smoking.

      fig 1.tif

      8eea62084ca7e541d918e823422bd82e Conclusion

      Patients should be counselled to stop smoking prior surgery independently as the QoL has expected to increase.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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