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Yogita S. Patel
MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
MA16.05 - Wearable Technology for Preconditioning Before Thoracic Surgery: A Feasibility Study (Now Available) (ID 2642)
15:45 - 17:15 | Presenting Author(s): Yogita S. Patel
Preconditioning before surgery can lower complication rates, but there are significant barriers to its adoption in the lung cancer population, which is characteristically older, suffers multiple comorbidities, and is averse to exercise. In an effort to overcome these barriers, we designed Move For Surgery (MFS), a home-based, preoperative preconditioning program which involves aerobic exercise using wearable technology and deep breathing exercises. We aimed to test the feasibility of MFS in preparation for a randomized controlled clinical trial.Method
In this prospective feasibility study, patients undergoing resection for NSCLC were preoperatively enrolled and provided with a wearable activity tracker (Fitbit) and a booklet describing various aerobic exercises, deep breathing exercises, and nutritional and smoking cessation tips. The daily step count, sleep cycle, and calories burned were synced and tracked remotely. Daily step goals were set by increasing the participants’ baseline step count by 600 steps each week until the day of surgery. Participants were encouraged and motivated to reach their daily step goal by daily automatic reminders through the Fitbit. Participants completed the EQ-5D-5L health-related quality of life instrument at baseline and on the day of surgery. Data is presented as mean +/- SD and median (range). Continuous variables were compared using Student’s t-test, and categorical variables were compared using Chi-square or Fischer’s exact test, with a level of significance p<0.05.Result
Of the 40 patients screened, 62.5% (25/40) were eligible and enrolled. Of the 15 not eligible, 80% (12/15) did not have a smartphone. Participants (n=25) were enrolled from 11/2017 to 07/2018. Median age was 62 (33-82) and 72% (18/25) were women. The mean predicted FEV1 and DLCO were 88.9% +/- 23.4% and 74.9% +/- 19.8% respectively. Participants spent a median of 25 days (8-55) on trial, and wore their Fitbits 90.0% +/- 25.2% of the time. The mean baseline daily step count for this cohort was 7,586 +/- 4,082, and the participants were able to achieve the daily step goal in 40.8% +/- 30.0% of the time. Participants with higher baseline step counts (≥6,000/day) were more likely to achieve the daily step goals (52.2% vs 20.5%; p=0.0083). Significant improvement was seen in the overall health component of the EQ-5D-5L from before the intervention (76.4 +/- 15.45) to after the intervention (80.4 +/- 14.57; p=0.03). Overall, 96.0% (24/25) of the participants completed the recommended deep breathing exercises, 100% (25/25) recommended MFS for future patients, and 96.0% (24/25) stated they will buy their own Fitbits and continue this lifestyle post-surgery.Conclusion
A preoperative preconditioning trial with wearable technology prior to lung cancer resection is feasible based on encouraging enrollment rates, use of the device, and goal achievement, but it is only applicable to participants with smart devices. MFS motivates patients to undergo preconditioning before lung cancer resection and to continue with a healthy lifestyle after surgery. A revision of the daily step goal is required to improve compliance. A randomized trial is in progress to determine the impact of MFS on postoperative outcomes in the thoracic surgery population.
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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
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): Yogita S. Patel
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.
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.