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Andrew M Blakely
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
MA16.06 - Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults (Now Available) (ID 2875)
15:45 - 17:15 | Author(s): Andrew M Blakely
Outcomes of oncologic resection are related to tumor biology as well as patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery are currently lacking.Method
We identified lung cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with 1) baseline HRQOL survey prior to cancer diagnosis and 2) follow-up survey at least one year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed using Cox proportional hazards regression in regard to overall survival (OS) and disease-specific survival (DSS).Result
Overall, 138 patients were evaluated, of whom 67 (49%) were male. Mean age at diagnosis was 74 years. The majority of patients were Caucasian (n=112, 81%). Disease extent was localized for 75 (54%), regional for 58 (42%), and distant for 5 (4%). In general, the cohort experienced a decline in physical HRQOL, mental HRQOL, and ADLs; and an increase in the number of major comorbidities (see Table). Median OS was 74 months. Decreased OS was independently associated with male sex (HR 1.7, p=0.03), more advanced disease (regional vs. localized: HR 1.8; distant vs. localized: HR 2.1; p=0.04), and decline in ADLs (HR 1.8, p=0.02). Decreased DSS was independently associated with male sex (HR 2.2, p=0.03), more advanced disease (regional vs. localized: HR 2.9; distant vs. localized: HR 3.1; p=0.01), and decline in mental HRQOL (OR 2.1, p=0.02).
The potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may in turn optimize oncologic outcomes.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
P2.17-33 - Deterioration in Health-Related Quality of Life Is Associated with Lower Lung Resection Rates in Older Adults (ID 2863)
10:15 - 18:15 | Author(s): Andrew M Blakely
Decision making for surgical resection of lung cancer is based on disease characteristics as well as patient-reported health factors. However, data regarding influence of functional status and health-related quality of life (HRQOL) on consideration for lung surgery are currently lacking.Method
We identified lung cancer patients with localized disease from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who had 1) baseline HRQOL survey prior to cancer diagnosis and 2) follow-up survey at least one year after diagnosis were selected. Generalized estimating equation (GEE) model was used to compare patients who underwent surgery versus those who did not in regard to demographics and HRQOL measures.Result
Overall, 108 patients were evaluated, of whom 75 (69%) underwent surgery. Surgical patients were younger (mean 73 versus 80 years, p<0.0001); otherwise, patient groups were demographically similar. Surgery was not performed based on surgeon recommendation (n=21, 64%), contraindication(s) (n=9, 27%), or patients’ decision (n=3, 9%). Surgery and non-surgery groups experienced similar declines in physical HRQOL, mental HRQOL, and Katz aggregate ADL scores; and an increase in the number of major comorbidities (see Table). However, non-surgical patients had significant declines in specific individual ADLs, namely mobility and personal care activities, compared to surgical counterparts. On GEE, adjusting for age, non-surgical patients were significantly more likely to have decreased physical HRQOL (OR 5.7, p=0.008), mental HRQOL (OR 2.1, p=0.049), or ADL scores (OR 2.7, p=0.02); and multiple comorbidities (OR 2.3, p=0.046) compared to surgical patients.
Patient-reported outcomes reflect patients’ perception of their own health, potentially providing information critical to surgical decision making that is not similarly reflected in other assessment tools. Identification and mitigation of such factors may increase surgeons’ recommendation for lung resection for patients with localized malignancy.