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Upal Basu Roy
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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
- Moderators:Jair Bar, Navneet Singh
- Coordinates: 9/09/2019, 15:45 - 17:15, Interlaken (1988)
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MA16.01 - Project PRIORITY: A Patient-Founded and Patient-Driven Research Partnership on Real-World Data on EGFR-Positive Lung Cancer (Now Available) (ID 2918)
15:45 - 17:15 | Author(s): Upal Basu Roy
- Abstract
- Presentation
Background
Despite increases in PFS in EGFR-positive lung cancer patients due to EGFR TKIs, patients eventually develop resistance to these drugs. Project PRIORITY (Patient Reported Initiative On Resistance, Incidence, Treatment studY) is a patient-founded and patient-driven longitudinal study aimed at understanding unmet needs of the global EGFR-positive lung cancer community.
Method
A comprehensive 103-question, IRB-approved patient-facing survey about the diagnostic and treatment journey of patients (including risk factor exposure, treatments, symptom and side-effect management, access to biomarker testing and clinical trials) was developed with input from US FDA statisticians and expert clinicians, and then pilot-tested among English-speaking patients both locally and internationally. Differences between US and international participants were analyzed by Chi-square (for categorical variables) and ANOVA.
Result
Of the 253 respondents, 27.7% were international participants. In line with previous studies with EGFR patients, participants reported low rates of active tobacco exposure (16.4%) and high rates of second-hand tobacco exposure (34.7%). Also, first-line use of afatinib (OR = 2.5, p <0.05) and erlotinib (OR = 3.3, p< 0.05) were associated with the development of a T790M mutation reflecting similarity in clinical characteristics.
US participants were more likely to report childhood exposure to secondhand smoke, family history of cancer (other than lung cancer), use of more than one line of therapy, and combination first-line therapy (P<0.05 for all variables).
International participants were more likely to report first-line treatment with 1st/2nd generation TKI, less use of tissue and plasma NGS, lower clinical trial participation, and more use of whole-brain radiation for brain metastasis (P<0.05 for all variables).
Conclusion
This first-of-its-kind international study provides a comprehensive picture of the treatment of EGFR-positive lung cancer patients in the real-world setting and highlights the existence of diagnostic (low NGS rates) and treatment gaps (low clinical trial participation and different treatment sequencing) both within the US and internationally.
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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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MA24.03 - Factors Impacting Patients’ Worries (Accessing Treatment, Treatment Toxicity, & Emotional Burden) Associated with Lung Cancer Treatments (Now Available) (ID 2589)
14:30 - 16:00 | Author(s): Upal Basu Roy
- Abstract
- Presentation
Background
Understanding patient experiences with lung cancer can guide research, treatment, and policy decisions. Conducted as part of a larger study (Project Transform) that aimed to quantified patient experiences, we sought to study the primary concerns of lung cancer patients and their caregivers and to determine what demographic and clinical factors impact these worries.
Method
Lung-cancer worries were identified from patient interviews and the literature. A novel an instrument assessing 13 potential worries on a 3-point importance scale was incorporated as part a national survey of lung cancer patients (inclusive of all types/stages of disease) and caregivers recruited through LUNGevity Foundation. Factor analyses was used to identify key constructs among the 13 worries. We then explored variation in the standardized factor scores across demographic and clinical indicators collected in the survey.
Result
Of the 426 participants in the survey, there were 385 patients and 41 caregivers. The average age of respondents was 58.9 years, 54% earned less than $75,000 per year, and 67.6% had completed college. Three factors were identified associated with worrying: 1) “accessing treatments” (incorporating knowledge, communication, access); 2) “treatment toxicity” (incorporating both side-effects and financial impact); and 3) “emotional burden” (including worries about dying, emotional toll, and being a burden), with Cronbach’s alphas of 0.89, 0.73, and 0.74 respectively. Worries about accessing treatment were lower among NSCLC (P=0.006), presence of MET mutations (P = 0.027) and those not currently receiving therapy (P=0.033). Worries about treatment toxicity were higher among non-white (P<0.001), non-retired (P<0.001), those earning less than $75,000 (P<0.001), younger patients (P<0.001), and those with ALK (P=0.026) or HER2 (P=0.041) mutations. Worries about treatment toxicity were lower among patients on Medicare or Medicaid during treatment (P = 0.023) and NSCLC patients (P=0.018). Worries about the emotional burden of treatment were lower among those >=60 years (P=0.002) and those who are retired (P=0.021) and higher among those having surgery (P=0.039).
Table 1: Marginal effects of patient factors on standardized worry scores
Factor
Accessing Treatment
Treatment toxicity
Emotional burden
Patient
-0.052 (0.16)
-0.144 (0.16)
-0.224 (0.16)
Age >= 60
-0.1 (0.1)
-0.336 (0.1)***
-0.309 (0.1)**
Female
0.003 (0.12)
0.239 (0.12)
0.158 (0.12)
Non-white
-0.022 (0.16)
0.56 (0.16)***
0.048 (0.16)
Hispanic, Latino, or Spanish
-0.003 (0.22)
0.233 (0.22)
0.161 (0.21)
Primary Language - Spanish
0.116 (0.7)
0.879 (0.69)
0.423 (0.67)
Armed Forces
-0.103 (0.18)
-0.134 (0.18)
0.055 (0.18)
Marries
0.139 (0.11)
-0.177 (0.11)
0.073 (0.11)
Has children
0.004 (0.13)
-0.031 (0.13)
0.203 (0.12)
College or professional degree
0.208 (0.11)
-0.096 (0.11)
-0.104 (0.1)
Retired
-0.048 (0.1)
-0.488 (0.1)***
-0.233 (0.1)*
Household Income < $75,000
0.031 (0.11)
0.376 (0.11)***
0.025 (0.11)
Population < 2,500
-0.168 (0.22)
-0.099 (0.22)
0.193 (0.21)
Chronic conditions as diagnosis
-0.078 (0.12)
-0.021 (0.12)
0.146 (0.12)
NSCLC
-0.308 (0.11)**
-0.263 (0.11)*
-0.111 (0.11)
Private Insurance
0.084 (0.11)
0.139 (0.11)
0.057 (0.11)
Medicare or Medicaid
0.02 (0.1)
-0.235 (0.1)*
-0.079 (0.1)
Other Insurance
-0.092 (0.17)
-0.144 (0.17)
-0.128 (0.17)
No Insurance
0.363 (0.58)
0.56 (0.58)
-0.083 (0.58)
Participated in a clinical trial
-0.029 (0.12)
-0.134 (0.12)
0.077 (0.12)
ALK
0.143 (0.14)
0.295 (0.13)*
0.041 (0.12)
BRAF
-0.241 (0.56)
-0.663 (0.55)
-0.345 (0.52)
EGFR
-0.038 (0.13)
-0.109 (0.13)
0.121 (0.12)
HER2
0.689 (0.48)
0.973 (0.47)*
0.439 (0.45)
KRAS
-0.201 (0.21)
-0.067 (0.21)
-0.113 (0.2)
MET
-0.765 (0.34)*
-0.389 (0.34)
0.19 (0.32)
NTRK
0.767 (0.68)
0.467 (0.67)
0.101 (0.63)
RET
0.154 (0.4)
-0.47 (0.39)
-0.69 (0.36)
ROS1
0.149 (0.26)
-0.053 (0.25)
0.202 (0.24)
More than 2 lines of treatment
0.09 (0.1)
0.026 (0.1)
0.03 (0.1)
Chemotherapy
0.019 (0.16)
0.008 (0.16)
0.007 (0.16)
Radiation
0.197 (0.29)
0.339 (0.3)
0.101 (0.3)
Targeted therapy
0.143 (0.1)
0.038 (0.1)
0.129 (0.1)
Immunotherapy
0.124 (0.18)
0.188 (0.19)
-0.125 (0.19)
Surgery
0.454 (0.29)
0.407 (0.3)
0.612 (0.29)*
Angiogenesis inhibitors
0.081 (0.41)
0.101 (0.42)
0.268 (0.42)
No current treatment
-0.214 (0.1)*
-0.192 (0.1)
-0.163 (0.1)
Notes: Standard errors in parentheses, * p<0.05, ** p<0.01, ***p<0.001
Conclusion
Conclusion:
Patients worry to differing extents about accessing treatment, treatment toxicity, and the emotional burden of lung cancer, yet caregivers and patients (on the whole) have similar worries. Lung cancer researchers, clinicians, and policymakers should make decisions in ways that address the heterogeneous experience of patients. Patients worries vary across a confluence of demographic, disease, and treatment factors, hence greater attention to the individual needs of the patient is needed.
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P1.14 - Targeted Therapy (ID 182)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.14-29 - Disrupting the Paradigm: Partnering with Oncogene-Focused Patient Groups to Propel Research (ID 1498)
09:45 - 18:00 | Author(s): Upal Basu Roy
- Abstract
Background
Genomic alterations drive more than 60% of adenocarcinoma cases of non-small cell lung cancer (NSCLC). About 20% of cases will have an oncogenic driver (EGFR, ALK, ROS1, BRAF, NTRK, etc.) that can be treated with approved targeted therapy drugs, and more (RET, Exon 20 insertions, etc.) have clinical trial options. Patients and caregivers dealing with these cancers have organized globally into oncogene-focused groups (“Groups”—see Table 1) and are building partnerships that seek to provide support, increase awareness and education, accelerate and fund research, and improve access to effective diagnosis and treatment.
Method
We partnered in a variety of ways to accelerate research. While each Group sets its own research priorities, we’ve found successful collaborative research has the following seven characteristics. It includes patients from the start, in all aspects of the project. It addresses questions meaningful to patients. It develops patient-centered measurements. It accommodates patients’ clinical realities. It leverages social media and patient groups. It shares progress with participants frequently. It makes results rapidly and freely available.
Result
These methods have enabled the Groups to collaborate successfully with clinicians, researchers, advocacy organizations, and industry to generate ideas for next steps in research for their disease, forge new studies and clinical trials for a specific oncogenic driver, create new patient-derived models of oncogene-driven cancers to study acquired resistance, develop registry-based studies to collect real-world data, and guide patients to clinical trials.
Conclusion
Oncogene-focused patient-caregiver groups are creating new paradigms across the research continuum. They have demonstrated that their partnerships with advocacy organizations, clinicians, researchers, and industry, can increase available patient-derived models, patient data, and specimens among geographically distributed, oncogene-driven cancer populations.
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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
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P1.16-21 - Does Age Affect What Patients Value When Considering Lung Cancer Treatments? Evidence from a National Survey (ID 1947)
09:45 - 18:00 | Presenting Author(s): Upal Basu Roy
- Abstract
Background
Few studies have explored how values vary with patients’ lung cancer treatment experience. Due to the rapidly increasing number of treatments for lung cancer, we sought to demonstrate a simple values-elicitation method and explore how values differ across age.
Method
The values of patients and caregivers with small cell (SCLC) and non-small cell lung cancer (NSCLC) inclusive of all stages were explored using a simple values elicitation exercise developed in partnership with diverse stakeholder advisory boards. Respondents were presented with five treatment characteristics, including progression free survival (PFS), short-term side effects (ST-SE), long-term side effects (LT-SE), and mode of administration. All characteristics and plausible outcomes were described. Values were elicited using a simple three-point Likert scale spanning not important, somewhat important, and very important, which were scored as 0, 5, and 10 respectively. Data came from a national survey completed in partnership with LUNGevity and other partners. Differences in values were explored between patients and caregivers, as well as across patients’ self-reported age with two sample t-tests.
Result
Among 793 eligible respondents, 556 were patients (70%) with 77% NSCLC, 11% SCLC, 12% unknown subtype and 233 were caregivers (30%). The average patient age was 58.4 years (y) (SD = 12.3), with 235 (42%) < 60y and 321 (58%) ≥60y. PFS was the most important attribute for respondents, but was undervalued by caregivers compared to patients (mean score (MS): 8.1 v 8.6, P = 0.014). Caregivers overvalued the importance of ST-SE (MS: 7.0 v 6.1, P < 0.001), LT-SE (MS: 8.4 v 7.6, P = 0.001), and mode of administration (MS: 6.9 v 6.1, P = 0.006). PFS was the most important attribute and valued similarly among younger vs. older patients (MS: 8.7 v 8.6, P = 0.76). However, ST-SE (MS: 6.4 v 5.8, P = 0.042) and LT-SE (MS: 8.0 v 7.4, P = 0.018) were more important among patients < 60y vs. ≥60y, respectively.
Conclusion
Among patients with lung cancer, progression free survival was highly valued regardless of patient age. Older patients value short term and long term side effects differently as compared to younger patients.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-32 - Project ACTS (Adherence to CT Screening): Developing Patient Engagement Tools to Support Lung Cancer Screening Adherence (ID 2928)
10:15 - 18:15 | Presenting Author(s): Upal Basu Roy
- Abstract
Background
The National Lung Screening Trial and the NELSON trial have established that low-dose computed tomography (LDCT) is beneficial for early detection of lung cancer among high-risk individuals. In 2014 the USPSTF began recommending LDCT scans for people at high risk for developing lung cancer. Part of the recommendation includes annual screening as well as follow-up for abnormal scans per Lung-RADS recommendations. However, rates of adherence to annual screening have been less than desirable with some screening programs anecdotally reporting rates as low as 20% and 50%. Concerns have also been raised regarding adherence to recommended interval scans following suspicious LDCT results. To address this need, Project ACTS aims to create a toolkit to facilitate lung cancer screening (LCS) adherence rates by addressing barriers and enhancing facilitators to participating in lung cancer
Method
To explore barriers and facilitators of screening program adherence, this study employed a sequential qualitative and quantitative assessment to identify components of a successful screening adherence paradigm. Semi-structured interviews and surveys were conducted with 15 Lung Cancer Screening (LCS) Program Directors and staff and 8 LCS Program Participants. Interviews were transcribed and analyzed using direct content analysis.
Result
Using the socio-ecological model of health promotion as a conceptual framework for analysis, the team mapped interview and survey findings to identify facilitators and barriers to adherence. Significant findings included: (1) the importance of personalized delivery of scanning results, embedding the opportunity to ask questions; (2) positive interactions with the CT techs; (3) the importance of a consistent program contact for engagement and continuity of care; (4) preference for increased screening accessibility with more locations and the option of weekend or later hours; and (5) the benefits of an active reminder system that utilizes multiple communication approaches. In addition, LCS program staff indicated interest in receiving training in shared decision-making and patient engagement strategies.
Conclusion
Our formative research highlights the complex and multi-factorial nature of screening adherence and identifies facilitators and barriers that may impact optimal adherence. The next step in this research will involve development, usability testing, and pilot studies of the proposed patient engagement toolkit.
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PR01 - Press Conference (ID 92)
- Event: WCLC 2019
- Type: Press Conference
- Track:
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/07/2019, 16:00 - 17:30, CC7.1 A&B
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PR01.04 - STARS Program Announcement (Now Available) (ID 3602)
16:00 - 17:30 | Presenting Author(s): Upal Basu Roy
- Abstract
- Presentation
Abstract not provided
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