Virtual Library

 x 
My Library Virtual Library FAQ

Start Your Search

Mitchell Von Itzstein



Author of

  • +

    MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • +

      MA06.02 - NSCLC Surgery Outcomes Between Facility Types and Association with Guideline Directed Surgical Quality of Care Metrics  (Now Available) (ID 2245)

      13:30 - 15:00  |  Author(s): Mitchell Von Itzstein

      • Abstract
      • Presentation
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) treatment outcomes differ between facility types. Surgical outcome differences may be related to modifiable factors and likelihood of receiving guideline centered care, which could be improved with new policy initiatives. We therefore analyzed the National Cancer Database (NCDB), to determine the variables related to different outcomes between facility types.

      Method

      The NCDB is a cancer registry curated by the Commission on Cancer that captures demographic and clinical data for an estimated 80% of NSCLC patients in the United States. A retrospective analysis of the NCDB was performed from 2004-2013 for Stage 1, 2 and 3a NSCLC patients treated with surgery. We compared overall survival between academic comprehensive cancer programs (ACAD) and community cancer programs (CCP) and four surgical quality metrics; lobectomy or greater vs sublobectomy, positive vs negative margin status, whether regional lymph node (LN) surgery was performed and number of nodes removed (less that 10 or equal to or greater than 10), in addition to 16 other demographic and clinical variables known to affect NSCLC survival. Kaplan-Meier estimates, log-rank test, multivariate Cox proportional hazard models and propensity score matching were used to evaluate survival differences while adjusting the effects of covariates. Quality of matching was checked using Wilcoxon rank sign test, chi-square test, and multivariate logistic regression models.

      Result

      The total cohort was 75,976 patients. After propensity matching for clinical and demographic variables, median overall survival (OS) for Stage 1, 2 and 3a was 76, 51 and 36 months for ACAD and 67, 43 and 32 months for CCP respectively (p<0.002 for all). Overall, selection of lobectomy or greater was the same between facility types (p=0.645), but ACAD were more likely to have negative margins (92.3% vs 89.8%, p<0.00001), perform LN dissection (89.5% vs 84.3%%, p<0.00001) and remove greater than 10 LN (37.4% vs 23.1%%, p<0.00001). After contrast matching for the surgical quality metrics, OS for Stage 1, 2 and 3a was 73, 49 and 34 months for ACAD and 67, 43 and 32 months at CCP respectively, with a non-significant P value for Stage 3a sub-cohort. Analysis revealed that the four key surgical quality measures explained 38% of the OS difference in median survival (p<0.00001).

      Conclusion

      In this large cohort of Stage 1, 2 and 3a NSCLC patients treated surgically, OS was higher at ACAD compared to CCP, which was in part explained by differences in surgical quality metrics. In the era of discussions of nationalized healthcare, policymakers will need to consider the differential treatment outcomes at different centers and consider consolidating treatment for NSCLC at high performing centers or improving the quality care measures of low performing centers.

      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.

      Only Active 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 or select "Add to Cart" and proceed to checkout.

  • +

    P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
    • +

      P1.16-01 - Complications Associated with Lung Biopsies in Patients with Lung Cancer: A Population Based Analysis (ID 2934)

      09:45 - 18:00  |  Author(s): Mitchell Von Itzstein

      • Abstract

      Background

      The discovery of molecular biomarkers that guide management of lung cancer has led to increasing frequency and amounts of tissue required for repeat lung biopsies.This has coincided with increased emphasis on patient safety and reporting on adverse events over the past two decades. The safety of repeat lung biopsies in patients with lung cancer has only been studied in small cohorts. We analyzed hospital-acquired adverse events for patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database from 2001- 2010.

      Method

      NHDS collects clinical information on patients discharged from non-Federal short-stay United States hospitals. Demographics, diagnoses, procedures, and mortality data were extracted using ICD-9 codes. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) were utilized to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4.

      Result

      An estimated 540,747 patients with lung cancer underwent lung biopsy during the study period and were included in the analysis; 61% were >65 years, 46% female, 65% white. Biopsy approaches included bronchoscopic (60%), percutaneous (33%), and surgical (7%). The number of lung biopsies increased over the study period, from 51,221 in 2001, to 63,239 in 2010 (P<0.001). Overall, 159,683 (30%) patients suffered ≥1-PSI event during their hospitalization, including an 11% incidence of pneumothorax. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients experiencing ≥1 PSI event increased from 24% in 2001, to 38% in 2010 (P<0.001). Patients with ≥1 PSI experienced higher in-hospital mortality (14.5% vs 3.2%, adjusted odds ratio, 5.9, 95% CI 3.9 – 8.9; P<0.001), and prolonged length-of-stay (11.6 vs 8.1 days; P<0.001).

      Conclusion

      The frequency of lung biopsies performed in lung cancer patients has increased in recent years, as has the rate of documented complications in this selected inpatient cohort. The increased rate of complications may be due to increased attention to and reporting of adverse events in this era focusing on patient safety, which has implications for policy makers and funding authorities. Investigators, sponsors, patients and regulatory authorities should be aware of the risks associated with repeat biopsies as they design, oversee, and analyze clinical trials. Non-invasive assessment of tumor biology, such as cell-free DNA, may help mitigate these risks.