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Phillip Hogg
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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
- Moderators:Joaquim Bosch-Barrera, Virginia Calvo De Juan
- Coordinates: 9/10/2019, 11:30 - 13:00, Interlaken (1988)
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MA19.02 - Psychological Distress in Never, Ex, Current, and Passive Smokers Diagnosed with Lung Cancer - Analyses from the EnRICH Program (Now Available) (ID 461)
11:30 - 13:00 | Author(s): Phillip Hogg
- Abstract
- Presentation
Background
Lung cancer is associated with greater psychological distress than any other cancer. In Australia, the prevalence of anxiety and depression in those with lung cancer is nearly 30% higher than the average of other major cancers. More than 50% of patients experience distress, anxiety and/or depression, resulting in diminished quality of life (QoL), and a fourfold increase in likelihood of suicide than the general population.
Lung cancer stigma, arising from presumption about tobacco exposure and associated smoking stigma, contributes to high levels of distress. A national survey found that more than a third (35%) of Australians believe those living with lung cancer “have only themselves to blame” and almost 40% indicated, before expressing concern, the first question they would ask someone diagnosed with lung cancer is whether they smoked. This stigma makes lung cancer patients reluctant to seek psychosocial support and reduces their sense of entitlement to care and empathy. However, approximately one fifth (21%) are life-long never-smokers.
This study aimed to describe differences in levels of psychological distress in never-and ever-smokers enrolled in the Sydney Catalyst EnRICH Program, a prospective clinical cohort of patients with lung cancer in New South Wales, Australia.
Method
Measures: EnRICH incorporates patient-reported outcome measures (PROMs) that assess dimensions of anxiety, depression, emotional function, and psychological distress, namely, the: (i) EORTC QLQ-C30; and (ii) NCCN Distress Thermometer.
Sample: All patients with newly diagnosed lung cancer presenting to study hospitals are eligible for the EnRICH cohort. Consenting patients who completed PROMs comprise the sample for the current analyses.
Statistical Methods: Subscales of the QLQ-C30 reflecting overall QoL and emotional function, and scores on the NCCN Distress Thermometer, were compared between patient groups by smoking status. Groups were combined into never-smokers (never, passive) and ever-smokers (ex, current) for analyses. Mean differences and 95% confidence intervals were computed.
Result
Among 205 patients who completed PROMs (69% of consenting patients), there were 52 never-smokers, 5 passive-smokers, 161 ex-smokers and 52 current-smokers at the time of diagnosis. Emotional function was worse in never-smokers (ever=75.3, never=63.2, difference=12.1 points 95%CI 2.4-21.7). There were no differences in other subscales. Although numbers are small, passive-smokers had the lowest mean scores for emotional-, role-, and social-functioning (Figure 1). Distress thermometer scores were 1.2 points worse in never-smokers [95%CI (0.56-1.8)].
Conclusion
Never-smokers had worse emotional function and higher distress than other lung cancer patients. If confirmed in larger studies, additional supportive care services may improve outcomes for these patients.
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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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P1.16-47 - Embedding Research (and Evidence) in Cancer Healthcare - EnRICH (ID 24)
09:45 - 18:00 | Author(s): Phillip Hogg
- Abstract
Background
In Australia, as in other regions, lung cancer persists as the most common cause of cancer related death and is the leading cause of morbidity and burden of disease. Improvements in lung cancer survival rates are not comparable with improvements for other cancers.
The Sydney Catalyst flagship program ‘Embedding Research (and evidence) in Cancer Healthcare – EnRICH’, is building a program of translational research in lung cancer to develop and extend evidence of effective treatments and to increase the use of clinical care based on existing evidence.
Specifically, this prospective clinical cohort of patients with lung cancer (non-small cell and small cell, any histological type, any clinical/pathological stage) will establish a comprehensive data platform, including biological samples (FFPE diagnostic tumour tissue, and serial pre- and post-treatment blood samples) with matched demographic, clinical, biomarker, molecular profile, and outcome data (including quality of care and patient-reported outcomes) to support a range of interconnected research from across the T1 – T3 translational research spectrum, from bench to bedside (and bedside to bench) through to policy and practice. A linked implementation science program will identify methods to promote better integration of research findings and evidence.
EnRICH will build on existing collaborations within Sydney Catalyst, across NSW, Australia, and internationally to establish a multidisciplinary program of research in scientific discovery, diagnostic and therapeutic development, clinical trials and implementation science.
Method
Aim
To assemble a patient cohort to: describe the natural history of and patterns of care for lung cancer; identify current gaps in evidence and practice for clinical quality improvement; create a platform for researchers across the T1-T3 translational research spectrum to develop and initiate clinical research and intervention studies to address gaps. Initially lung cancer will be an exemplar.
Design
Prospective clinical cohort of lung cancer patients including matched demographic, clinical, biomarker, molecular profile, and outcome data (including quality of care and patient-reported outcomes) for current and future research projects.
Planned sample size
At least 1000 patients. 505 patients enrolled at 31 Jan 2019.
Inclusion criteria
All patients with lung cancer presenting to defined clinical sites for diagnosis or treatment, including:
Patients with a new diagnosis of primary lung cancer (any histological type, any pathological/clinical stage including metastatic) undergoing primary treatment; curative or palliative
Patients with first progressive disease, local recurrence or new metastasis after completing previous treatment for non-metastatic disease at the time of initial diagnosis
Aged over 18 years
Data and biospecimen collection
Matched clinical and demographic data will be collected from patient medical records and hospital administrative data sets
Archival tissue, for research, will be obtained from routine biopsy specimens. Serial blood samples for research, on average 3 per patient (e.g. prior to commencement of treatment [baseline], and post-treatment [6 and 12 month follow-up])
Patient reported outcomes will be measured through questionnaires
Statistical considerations
The cohort will enable reliable estimates of outcomes both overall and within histologic and genetic sub-types.
Result
Section not applicable
Conclusion
Section not applicable
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-36 - Patterns of Care in a Prospective Clinical Cohort of Patients with Lung Cancer - Preliminary Analyses from the EnRICH Program (ID 1493)
10:15 - 18:15 | Author(s): Phillip Hogg
- Abstract
Background
Lung cancer accounts for 9% of all cancer diagnoses, is the most common cause of cancer related death, and is the leading cause of morbidity and burden of disease in NSW and across Australia. The outlook for patients with lung cancer remains poor with only a 15% overall five year survival rate. For patients diagnosed with advanced stage disease, five year survival is less than 5%. There is an urgent need to identify and reduce unwarranted clinical variation that may contribute to morbidity and burden of disease, and to improve quality of care, and thereby ensure best possible outcomes, for the lung cancer population.
Sydney Catalyst is addressing this need through the Embedding Research (and Evidence) in Cancer Healthcare 'EnRICH' program, a program of translational research in lung cancer which aims to: describe the natural history of and patterns of care for lung cancer; identify current gaps in evidence and practice for clinical quality improvement; and create a platform for researchers across the T1-T3 translational research spectrum to develop and initiate clinical research and intervention studies to address gaps.
The EnRICH dataset currently includes comprehensive patient, diagnostic, treatment and outcome data (including patient reported outcomes) for more than 600 consecutive patients with lung cancer (non-small cell and small cell, any histological type, any clinical/pathological stage) treated in metropolitan and regional hospitals across three Local Health Districts in NSW, Australia. By mid-2020, the EnRICH dataset will include data for more than 1000 patients.
Method
This preliminary analysis will provide descriptive data on the first 500 consecutive patients in the EnRICH cohort and, specifically, will describe patterns of care stratified by patient and disease characteristics. Patterns of care will be mapped to evidence-based quality indicators to identify clinical variation.
Result
Data collection is complete for 420 patients. Remaining data collection and analyses will be complete for 500 consecutive patients by 19 July 2019. Data presented will include:
Descriptive data
Patient characteristics: age; sex; CALD status; comorbidities, symptoms, performance status
Risk factors: smoking history; family history of lung cancer; occupational exposure; clinical history of lung disease; previous malignancy
Disease characteristics: histological type and sub-stype; pathological stage; clinical stage; genetic mutations
Quality indicators
Diagnosis - proportion with: clinical stage; pathological stage; appropriate analysis of predictive markers; time from diagnosis to treatment
Treatment - proportion: with performance status assessment; reviewed by MDT; undergoing resection, chemotherapy, targeted-therapy, immunotherapy, radiotherapy; receiving no active anti-cancer treatment
Referral - proportion: of current smokers with documented smoking cessation counselling; of stage IV patients referred to palliative care; referred to supportive care services; referred to/enrolled in clinical trials
Outcomes
Clinical outcomes: major complications (Clavien-Dindo/CTCAE grade ≥3); hospitalisations; survival
Patient reported outcomes: Global health status/QoL; social functioning; physical functioning; role functioning; emotional functioning; cognitive functioning; social functioning; symptoms; distress
Conclusion
Data from EnRICH for the first 500 consecutive patients treated for lung cancer across a wide geographical area in NSW, Australia will map routine patterns of care, and identify unwarranted clinical variation to be addressed by quality improvement interventions to achieve best possible patient outcomes.
