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Mary M. Pasquinelli

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    MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)

    • 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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      MA19.01 - Empirical Identification of Distress Clusters in Lung Cancer Patients (Now Available) (ID 2085)

      11:30 - 13:00  |  Author(s): Mary M. Pasquinelli

      • Abstract
      • Presentation
      • Slides


      Screening for distress from the time of diagnosis is emerging as standard cancer care. Although there is heterogeneity in patients’ experience of distress, identification of subgroups of patients with unique distress profiles may inform interventions for distressed patients. Accordingly, we aimed to identify unique subgroups of patients based on their distress screening responses from a large sample of newly diagnosed lung cancer patients across two urban academic medical centers in Chicago, IL.


      Lung cancer patients (N=596) were screened for distress at their diagnostic visit between (2/22/16 – 8/14/18) with the Coleman Foundation “Patient Screening Questions for Supportive Care” tool; a 34-item screener that identifies patient needs across psychological, physical, family/caregiver, and treatment and care concerns. A Two-Step cluster analysis was conducted to identify natural clusters of patients based on similar responses to distress screening items.


      Cluster analysis results revealed a two-cluster outcome: “High Distress” (N=332) and “Low Distress” (N=264). The items that best distinguished High Distress patients from Low Distress patients were concerns about cancer stage/diagnosis, concerns about prognosis/long-term outcome, concerns about treatment options, and having higher average number of total concerns. Cancer stage at screening was not predictive of cluster membership. Demographic characteristics, descriptive statistics, and group difference tests for survey items by cluster and for the total sample are presented in Table 1.


      More than half of lung cancer patients were grouped as experiencing high distress on screening. While cancer stage was not predictive of high distress grouping, concerns about stage, treatment, and prognosis were most predictive of high distress cluster membership. An intervention to improve communication between providers and patients about these concerns may reduce distress.

      Table 1

      High Distress (N=332/55.7%)

      Low Distress (N=264/ 44.3%)

      Total Sample (N=596)





      M=65.75 (SD=9.95)

      M=66.25 (SD=9.71)

      M=65.97 (SD=9.84)

      F=.39 (p>.05)


      N=171 (51.5%)

      N=144 (54.5%)

      N=315 (52.9%)

      χ2=.55 (p>.05)


      χ2=30.83 (p<.01)


      N=124 (37.3%)

      N=154 (58.3%)

      N=278 (46.6%)


      African American

      N=161 (48.5%)

      N=72 (27.3%)

      N=233 (39.1%)



      N=47 (14.2%)

      N=38 (14.4%)

      N=85 (14.3%)


      Stage IV

      N=160 (48.2%)

      N=118 (44.7%)

      N=278 (46.6%)

      χ2=.72 (p>.05)

      Physical & Psychological Health

      Psychological Distress (PhQ-4)

      M=3.55 (SD=3.63)

      M=1.56 (SD=2.14)

      M=2.67 (SD=3.29)

      F=58.86 (p<.01)


      M=5.13 (SD=4.76)

      M=4.76 (SD=3.45)

      M=4.99 (SD=3.66)

      F=1.04 (p>.05)


      M=8.56 (SD=5.31)

      M=7.63 (SD=4.74)

      M=8.15 (SD=5.01)

      F=4.34 (p<.05)

      Physical Activity

      M=12.63 (SD=7.74)

      M=16.70 (SD=8.52)

      M=14.42 (SD=8.33)

      F=35.55 (p<.01)


      Practical Concerns


      N=8 (2.5%)

      N=2 (.8%)

      N=10 (1.7%)

      χ2=2.43 (p>.05)

      Food & Housing

      N=58 (17.8%)

      N=13 (5.0%)

      N=71 (12.2%)

      χ2=22.06 (p<.01)


      N=72 (22.0%)

      N=14 (5.4%)

      N=86 (14.7%)

      χ2=31.29 (p<.01)


      N=19 (5.9%)

      N=8 (3.1%)

      N=27 (4.7%)

      χ2=2.49 (p>.05)

      Paying for Medication

      N=79 (24.1%)

      N=35 (13.6%)

      N=114 (19.5%)

      χ2=10.19 (p<.01)

      Family/Caregiver Concerns


      N=46 (18.7%)

      N=18 (8.0%)

      N=64 (13.6%)

      χ2=11.58 (p<.01)


      N=51 (20.9%)

      N=24 (10.6%)

      N=75 (15.9%)

      χ2=9.37 (p<.01)


      N=23 (9.5%)

      N=8 (3.5%)

      N=31 (6.6%)

      χ2=6.91 (p<.01)

      Ability to have children

      N=8 (3.3%)

      N=2 (.9%)

      N=10 (2.1%)

      χ2=3.35 (p>.05)


      N=62 (25.6%)

      N=24 (10.5%)

      N=86 (N=18.3%)

      χ2=18.07 (p<.01)

      Treatment & Care Concerns

      Cancer Diagnosis & Stage

      N=303 (93.5%)

      N=8 (3.3%)

      N=311 (55.1%)


      Prognosis & Long-term Outcome

      N=312 (95.7%)

      N=37 (15.4%)

      N=349 (61.6%)

      χ2=378.04 (p<.01)

      Treatment Options

      N=246 (75.7%)

      N=11 (4.6%)

      N=257 (45.4%)

      χ2=282.43 (p<.01)

      Communicating treatment wishes

      N=165 (52.1%)

      N=7 (2.9%)

      N=172 (30.8%)

      χ2=155.09 (p<.01)

      Physical Health Concerns


      N=160 (64.3%)

      N=78 (35.5%)

      N=238 (50.7%)

      χ2=38.77 (p<.01)


      N=86 (43.4%)

      N=41 (20.0%)

      N=127 (31.5%)

      χ2=25.63 (p<.01)


      N=47 (27.0%)

      N=17 (8.5%)

      N=64 (17.1%)

      χ2=22.68 (p<.01)


      N=22 (13.3%)

      N=4 (2.1%)

      N=26 (7.2%)

      χ2=16.72 (p<.01)


      N=66 (33.7%)

      N=16 (8.1%)

      N=82 (20.8%)

      χ2=39.15 (p<.01)


      N=137 (59.3%)

      N=58 (27.4%)

      N=195 (44.0%)

      χ2=45.79 (p<.01)


      N=46 (26.1%)

      N=12 (6.0%)

      N=58 (15.5%)

      χ2=28.79 (p<.01)


      N=49 (27.1%)

      N=18 (9.1%)

      N=67 (17.7%)

      χ2=21.01 (p<.01)

      Mouth Sores

      N=24 (14.5%)

      N=13 (6.6%)

      N=37 (10.2%)

      χ2=6.18 (p<.05)

      Dry Mouth

      N=116 (53.2%)

      N=51 (24.5%)

      N=167 (39.2%)

      χ2=36.76 (p<.01)

      Swollen Arms or Legs

      N=76 (39.6%)

      N=21 (10.5%)

      N=97 (24.7%)

      χ2=44.49 (p<.01)

      Feeling full quickly or swollen abdomen

      N=57 (32.0%)

      N=18 (9.2%)

      N=75 (20.1%)

      χ2=30.35 (p<.01)

      Sexual Intimacy or Functioning

      N=54 (28.3%)

      N=17 (8.4%)

      N=71 (18.0%)

      χ2=23.37 (p<.01)

      Dry/Itchy or Blistered Skin

      N=94 (46.3%)

      N=43 (20.7%)

      N=137 (33.3%)

      χ2=30.37 (p<.01)

      Tingling in hands/feet

      N=84 (43.5%)

      N=33 (16.8%)

      N=117 (30.1%)

      χ2=32.93 (p<.01)


      N=31 (19.35)

      N=14 (7.2%)

      N=45 (12.7%)

      χ2=11.52 (p<.01)

      Use of Alcohol or Drugs

      N=3 (2.0%)

      N=1 (.5%)

      N=4 (1.2%)

      χ2=1.59 (p>.05)

      Total # of Concerns

      M=7.84 (SD=3.71)

      M=2.53 (SD=2.47)


      F=400.82 (p<.01)

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    P1.11 - Screening and Early Detection (ID 177)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.11-06 - Expanding Criteria for Lung Cancer Screening Reduces Gender Disparity (ID 1517)

      09:45 - 18:00  |  Presenting Author(s): Mary M. Pasquinelli

      • Abstract


      Women smokers may be more susceptible to lung cancer with less cigarette exposure than men. The NLST found borderline greater mortality benefit to high-risk women screened for lung cancer than men. The NELSON trial found significantly greater mortality benefit for women than men (39-61% for women vs 26% in men at 10 years). Since the NELSON trial included individuals >50 years old and <20 pack-years smoking history (similar to the NCCN moderate risk group) the aim of this study was to evaluate a cohort of lung cancer patients to determine differences in meeting the USPSTF criteria versus the NCCN moderate risk criteria on the basis of gender.


      Gender, demographics, and smoking history were collected in a retrospective analysis of 703 smokers (current and former) diagnosed with lung cancer between 2010 – 2017 at an urban Chicago academic medical center. Cases were assessed for whether they would have met USPSTF (includes age 55-80, current smoker or former smokers quit time <15 years, >30 pack-years) and the NCCN moderate risk (includes age >50, current or former smokers, >20 pack-years) screening eligibility criteria.


      Women smoked less overall, were less likely to smoke >30 pack-years (p=0.0002) and less likely to meet USPSTF screening guidelines (46.7% women vs 61.0% of men, p=0.0007) than men (Table 1). This gender disparity in meeting eligibility criteria was reduced by >40% (from 14.4% to 8.0%) when expanding from USPSTF (61.0% men vs 46.7% woman) to the NCCN moderate risk criteria (80.7% men vs. 72.7% women). Women were diagnosed at an earlier stage than men (p=0.02).


      Women diagnosed with lung cancer had a lighter smoking history and were less likely to meet the USPSTF screening criteria than men. Expanding USPSTF criteria to include individuals age >50 and >20 pack-year smoking history decreased the gender disparity in meeting lung cancer screening guidelines.

      Table 1: Gender Variation in Lung Cancer Current and Former Smokers





      Total N = 703 (%)

      403 (57.33)

      300 (42.67)

      Age Mean (SD)

      64.36 (9.55)

      64.66 (9.15)


      Race/Ethnicity (%)


      Black, Non-Hispanic

      215 (53.35)

      182 (60.67)

      White, Non-Hispanic

      135 (33.50)

      88 (29.33)


      53 (13.15)

      30 (10.00)

      Smoking History (%)



      258 (64.02)

      190 (63.33)


      145 (35.98)

      110 (36.67)

      Pack Years of Smoking Mean (SD)

      45.33 (27.92)

      36.02 (23.38)


      Pack Years of Smoking (%)


      305 (75.68)

      181 (60.33)

      20- 30

      48 (11.94)

      55 (18.33)


      38 (9.43)

      43 (14.33)


      12 (2.99)

      21 (7.00)

      Quit-years for Former Smokers Mean (SD)

      12.98 (11.04)

      13.44 (11.93)


      Quit-years for Former Smokersa (%)


      97 (68.79)

      67 (62.04)


      44 (31.21)

      41 (37.96)

      Met Screening Criteria (%)



      246 (61.04)

      140 (46.67)

      NCCN moderate risk groupb minus those that met

      USPSTF criteria

      79 (19.60)

      78 (26.00)

      NCCN moderate risk groupb (includes USPSTF)

      325 (80.65)

      218 (72.67)

      Did not meet USPSTF or NCCN

      78 (19.35)

      82 (27.33)

      Stagec (%)




      63 (22.26)


      25 (6.51)

      18 (6.36)


      90 (23.44)

      55 (19.43)


      218 (56.77)

      147 (51.94)

      aN=249 (number of former smokers with known quit-year data)

      bNCCN moderate risk (age >50 with a smoking history of >20 pack years)

      cN=667 (number of lung cancer cases with known staging data)

      Abbreviations: NLST = National Lung Screening Trials; NELSON = Nederlands-Leuvens Longkanker Screening Network; USPSTF = United States Preventative Services Task Force; NCCN = National Comprehensive Cancer Network; N = number of cases; SD = Standard Deviation

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    P2.10 - Prevention and Tobacco Control (ID 176)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.10-08 - Association Between Smoking and Anxiety/Depression in Respiratory Tract Cancers (Now Available) (ID 1803)

      10:15 - 18:15  |  Author(s): Mary M. Pasquinelli

      • Abstract
      • Slides


      Several studies have shown that depression can reduce patients’ immune and endocrine functions. The prevalence of depression and anxiety is the highest among respiratory tract cancers, which in turn has a negative impact on treatment outcomes. Interestingly, patients with lung cancer have the highest rates of depression when compared to those with other types of cancers. We believe one possible reason for this is that they may suffer from the stigma that lung cancer is self-induced by smoking. Society has shifted perspectives greatly on how smoking is viewed. From widely disseminated anti-smoking ads to increased political campaigns and regulations to ban smoking in public spaces, lung cancer has now become almost synonymous with a disease of smoking. In this study, we analyzed the association between PHQ-4 scores and smoking status in lung and head and neck cancer patients.


      Medical records for 395 lung and head and neck cancer patients (never smokers=83, former smokers=142, and current smokers=170) at University of Illinois Hospital were assessed using the validated Patient Health Questionnaire (PHQ-4) scale, a four-item health questionnaire that measures anxiety and depression. Patient data from the two-year time May 2016 to Aug 2018 was matched for important demographics like age, race, sex, and cancer diagnosis.Multivariate analyses examined correlations between PHQ-4 score, smoking status (based on CDC definitions), and other characteristics including: insurance, pain level, fatigue level, level of physical concern, level of physical activity,


      Being a current smoker demonstrated a very strong correlation with elevated anxiety and depression levels (p = 0.0003), while being a former smoker did not have the same effect. Insurance also had a significant positive correlation, with Medicaid patients having the highest average PHQ-4 score (p = 0.02). As expected, pain, fatigue, physical concerns, and physical activity scores were also highly correlated with depression and anxiety with p < 0.0001 for all of these measures. A multivariate model adjusting for the most salient patient parameters affecting PHQ-4 distress scores was generated and found that being a smoker had a significant increase on PHQ-4 score of on average 0.84 points over non-smokers (p = 0.03). In this model, pain, fatigue, and physical concerns also had increases of 0.14, 0.22, and 0.25 respectively in PHQ-4 scores (p = 0.0046, p < 0.0001, and p < 0.0001).


      Our findings show that there is a correlation between smoking status, and PHQ-4 scores in lung and head and neck cancer patients. Distress and anxiety can interfere with a patient’s ability to effectively cope with cancer, its physical symptoms, and its treatment. Thus, screening for anxiety and depression, identifying it, and referring patients to smoking cessation clinics and other supportive services is an integral part of cancer treatment. Since lung and head and neck cancers are associated with smoking, patients feel that their smoking is the culprit of the disease, and this in turn can lead to self-inflicted stigma. We are currently investigating whether higher PHQ-4 scores in lung and head and neck cancer patients are correlated with higher levels of perceived cancer-related stigma.

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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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      P2.11-22 - Comparison of the Sensitivity of USPSTF and PLCOm2012 Lung Cancer Screening Criteria in a Racially Diverse Population (ID 855)

      10:15 - 18:15  |  Presenting Author(s): Mary M. Pasquinelli

      • Abstract


      Objective: To compare the sensitivity to detect lung cancer of two lung cancer screening selection criteria, the USPSTF (≥30 pack-years smoked, quit-time ≤15 years, age 55-80) and the PLCOm2012 model 6-year risk ≥1.5%, in a racially diverse population including a high proportion of Blacks.


      Lung cancer cases diagnosed at a Chicago academic hospital in 2010–2017 were retrospectively analyzed for whether they met lung cancer screening eligibility using the USPSTF and PLCOm2012 criteria. Contingency table analysis with McNemar’s odds ratios, confidence intervals and p-values evaluated comparisons.


      The race/ethnic distribution of the 823 lung cancer cases was 245 (29.8%) Whites, 435 (52.9%) Blacks, 75 (9.1%) Hispanics, 39 (4.7%) Asians, and 29 (3.5%) others. Overall, data on criteria risk factors were available for 770 (93.6%) individuals: 68.3% were positive by PLCOm2012 criteria and 49.9% were positive by the USPSTF (Table 1, McNemar’s odds ratio (ORM)=11.9, 95%CI 6.8-22.9, p<0.0001). Limited to Blacks, the USPSTF criteria identified 50.8% and the PLCOm2012 identified 74.9%. Only 3 individuals were USPSTF+ve/PLCOm2012-ve and 104 individuals were PLCOm2012+ve/USPSTF-ve (Table 2, ORM=34.7, 95%CI 11.5-170.8, p<0.0001).


      Overall and especially in Blacks, compared to the USPSTF criteria, the PLCOm2012 criteria was significantly more sensitive at identifying lung cancer patients.

      Table 1. Lung cancer cases (N=770) stratified by USPSTF and PLCOm2012 selection criteria status, all races/ethnicities. Cells contain number, (row percent), [column percent].

      PLCOm2012 risk < 1.5%

      PLCOm2012 risk >1.5%


      USPSTF criteria -ve










      USPSTF criteria +ve




















      Table 2. Lung cancer cases (N=419) stratified by USPSTF and PLCOm2012 selection criteria status, Black race only. Cells contain number, (row percent), [column percent].

      PLCOm2012 risk < 1.5%

      PLCOm2012 risk >1.5%


      USPSTF criteria -ve










      USPSTF criteria +ve