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Simon R Turner
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MA24 - Initiatives to Improve Health in Lung Cancer Patients (ID 354)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Advocacy
- Presentations: 1
- Now Available
- Moderators:Merel N. Mountain, Nicoleta Mitrea
- Coordinates: 9/10/2019, 14:30 - 16:00, Melbourne (1991)
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MA24.09 - Stigma in Early Stage Lung Cancer (Now Available) (ID 2883)
14:30 - 16:00 | Author(s): Simon R Turner
- Abstract
- Presentation
Background
Lung cancer stigma, arising from the causative relationship between smoking and lung cancer, can result in those with a lung cancer diagnosis being seen by themselves and others as responsible for and even deserving of their condition. Lung cancer stigma is linked to adverse outcomes for patients, including decreased quality of life and depression. Most studies have focused on stigma in patients with advanced lung cancer, whose experiences may differ from earlier stage, surgical patients with better prognosis. The objective of this study is to establish a baseline of stigma related experiences for patients presenting with early stage lung cancer. The overarching goal is to assist in determining appropriate interventions to decrease harmful stigma for patients with lung cancer.
Method
This study is a descriptive cross-sectional design using the 25-item previously validated Lung Cancer Stigma Inventory (LCSI). The LCSI was self-administered by patients with newly diagnosed lung cancer at a tertiary referral thoracic surgical clinic to quantitatively measure their experience of lung cancer stigma. Statistical comparisons were performed with Student’s t-test.
Result
128 patients were approached to participate and 53 completed the LCSI (response rate= 41.4%), 33 were women. All had resected early stage lung cancer except one patient staged pIIIA (I=41, II=11). 38 patients (71.7%) met the established threshold of a total LCSI score of 37.5, indicating a clinically meaningful level of stigma. Stigma was experienced predominantly on the Internalized Stigma subscale (mean 2.64/5), whereas scores on the Constrained Disclosure and Perceived Stigma subscales were lower (mean 1.84/5, 1.66/5). There was a trend towards higher overall stigma scores in current and former smokers compared to never smokers (mean 53.9 vs 39.8, p=0.12) There was no difference in stigma experience based on gender or stage, surgical approach or use of adjuvant chemotherapy.
Conclusion
A surgical population of patients with early stage lung cancer experienced lung cancer stigma at a high rate, and at a level similar to previously studied populations with more advanced disease. Respondents experienced more internal stigma than stigma stemming from society or others. Exploratory analysis of this study’s results have informed the development of a further study, currently underway, using patient interviews to better understand patients’ experiences of lung cancer stigma, which may help to identify potential interventions to decrease lung cancer stigma and its impacts.
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OA01 - Advanced Diagnostic Approaches for Intrathoracic Lymph Nodes and Peripheral Lung Tumors (ID 117)
- Event: WCLC 2019
- Type: Oral Session
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Now Available
- Moderators:Marioara Simon, Tim Murgu
- Coordinates: 9/08/2019, 10:30 - 12:00, Melbourne (1991)
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OA01.02 - Endobronchial Ultrasound Staging of Operable NSCLC: Triple Negative Lymph Nodes May Not Require Routine Biopsy (Now Available) (ID 2621)
10:30 - 12:00 | Author(s): Simon R Turner
- Abstract
- Presentation
Background
Current staging guidelines with endobronchial ultrasound (EBUS) still recommend systematic biopsy of at least 3 mediastinal stations prior to surgical resection. Recently, a 4-point ultrasonographic score (Canada Lymph Node Score- CLNS) was developed to determine the probability of nodal metastasis in any given lymph node. A LN with CLNS<2 is considered very low probability for malignancy. We hypothesized that, during EBUS assessment of patients with cN0 non-small cell lung cancer, individual nodal stations that have CLNS<2 do not require routine biopsy because they are likely to represent true pN0 disease.
Method
The CLNS is a prospectively validated score that uses four ultrasonographic features to accurately predict LN malignancy. LNs were evaluated for ultrasonographic features at the time of EBUS and the CLNS was applied. “Triple Negative” LNs were defined as cN0 on CT (LN≤1cm), PET (no hypermetabolic activity) and EBUS (CLNS<2). Specificity, NPV, and false-negative rates were calculated against the gold-standard pathological diagnosis from surgically excised specimens.
Result
In total, 122 LNs in 58 cN0 patients were assessed. Triple Negative LNs were associated with the following T-stage distribution (T1a=12.07%, T1b=24.14%, T2a=34.38%, T2b=10.34%, T3=17.24%, T4=1.72%). Triple Negative LNs had a specificity, NPV, and false-negative rate of 86.10% (95%CI: 78.40-91.80%), 93.40% (95%CI: 86.90-97.30%), and 6.60%, respectively when using <2 as the CLNS malignancy cut-off. In total, only 5.74%(n=7) Triple Negative nodes were actually proven to be malignant, 6/7 (85.71%) on EBUS-TBNA, and 1/7 (14.29%) only after surgical resection.
Conclusion
Triple Negative LNs have a high NPV for malignancy. At the time of EBUS in cN0 patients, it may be possible that Triple Negative LNs do not require tissue sampling, thereby saving procedural time, cost, and discomfort. Findings also suggest that Triple Negative LNs with inconclusive biopsy results may not require repeat sampling. A prospective comparative trial is required to confirm these findings.
Only 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, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
