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Virginia Sun



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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
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      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): Virginia Sun

      • Abstract
      • Presentation
      • Slides

      Background

      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).

      table.png

      Conclusion

      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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    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.11-19 - Effects of Incorporating a Lung Cancer Screening Educational Intervention into Tobacco Cessation Counseling (Now Available) (ID 669)

      10:15 - 18:15  |  Author(s): Virginia Sun

      • Abstract
      • Slides

      Background

      Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality in high-risk patients, but most of those eligible are not referred for screening, and most eligible smokers are not aware about LCS. Tobacco cessation counseling may be an opportune time to educate smokers about LCS, but it is unclear whether providing such information is effective in improving LCS utilization and what effects it may have on success of tobacco cessation.

      Method

      We randomized 1281 smokers age 55-80 who underwent tobacco cessation services between January 2016 and February 2018 in a large integrated health care system to view a web-based educational video about LCS (n=1026) or to receive usual care (n=255). We analyzed results according to both intention-to-treat as well as a pre-planned subset analysis of participants who completed the video. A survey on perceptions of LCS was included at the completion of the video and this was analyzed as well. We then compared the utilization of chest CT scan (any chest CT or specifically LDCT for LCS) in both groups of participants during a specified 90 day follow-up period and modeled the incidence rate ratios (IRR) for participants who completed the video and all invited to view the video compared with controls.

      Result

      In the intervention arm, 191 (14.9%) patients watched part of the video, and 136 (10.6%) of participants completed watching the video. The video was well received by those completing it. Overall, 47(4.6%) of participants in the intervention group underwent chest CT and 31 (3.0%) underwent LDCT compared with 12 (4.7%, p=0.082) and 7 (2.8%, p=0.30) in the control group during a 90 day follow-up. Among participants who completed watching the video, 18 (13.2%, p=0.033 compared with control) underwent chest CT and 10 (7.4%) underwent LDCT during follow-up (p= 0.003 compared with control). IRR for participants completing the video was 2.01 (95% CI 1.06-3.82, p=0.03) for LDCT compared with control, and 2.15 (95% CI 1.30-3.55, p=0.003) for chest CT compared with control.

      Conclusion

      These data suggest that a lung cancer screening educational intervention may be effective in improving utilization of LDCT in eligible smokers at the time of tobacco cessation counseling. Our study was limited by relatively low response rate to viewing the educational video. We plan to study the optimal way to deliver LCS education in the setting of tobacco cessation. Further research on the effect of lung cancer screening education on the effectiveness of tobacco cessation interventions is also needed.

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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
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      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): Virginia Sun

      • Abstract

      Background

      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.

      table.png

      Conclusion

      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.