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Qiuling Shi
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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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MA19.03 - Differences in Symptom Burden Between Responsive and Progressive Disease in Advanced Non-Small Cell Lung Cancer (aNSCLC) (Now Available) (ID 845)
11:30 - 13:00 | Author(s): Qiuling Shi
- Abstract
- Presentation
Background
We have established a real-world Advanced Non-Small Cell Lung Holistic Registry (ANCHoR) to assess how immunotherapy impacts treatment choice, clinical outcomes, and patient-reported outcomes (PROs) of aNSCLC. Our aim in this analysis was to assess the ability of the MDASI-LC to differentiate between patients who are responding or who are progressing during treatment.
Method
Between May 2017 and December 2018, patients with aNSCLC at a single institution were enrolled in ANCHoR and completed the MDASI-LC prior to therapy (PTT) and at routine clinic visits. The MDASI-LC consists of 16 symptom severity and 6 interference items rated on 0-10 scales (0 = no symptom or interference, 10 = worst imaginable symptom or complete interference). MDASI-LC scores from PTT to first recorded response determination (FRD) were compared by response group using linear mixed modeling (LMM).
Result
One hundred one patients completed the MDASI-LC PTT and at FRD. Mean patient age was 63.8 years (standard deviation = 10.29) and 55% were males. Fifty percent of patients received chemotherapy (CTX), 22% immunotherapy (IM), 19% CTX+IM or angiogenesis inhibitor, and 9% targeted therapy. Median time from PTT to FRD was 105 days (lower quartile = 63, upper quartile = 224). Forty-six percent of patients had a complete or partial response (RECIST criteria CR, PR), 14% had stable disease (RECIST SD), and 41% progressed (RECIST PD). LMM showed progressing patients had significantly more fatigue (estimated effect [est] =1.39; p = 0.031), sleep disturbance (est=1.37; p = 0.046), and drowsiness (est=1.33; p = 0.037) and reported significantly more interference with work (est=1.67; p = 0.016) over time than responding patients.
Conclusion
The MDASI-LC differentiated the symptom burden of patients with responding disease from that of patients with progressive disease. Patients with progressive disease had more fatigue, disturbed sleep, drowsiness, and greater interference with work than those with responsive disease. Further research is needed to determine if the MDASI-LC can predict response to therapy in patients and may be useful in delineating treatment benefit.
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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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P1.16-31 - Body Mass Index Relating to Patient-Reported Symptoms in First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (ID 2619)
09:45 - 18:00 | Author(s): Qiuling Shi
- Abstract
Background
Patient-reported outcomes (PROs) provide information on patient treatment experience. Our aim in this analysis was to assess the longitudinal relationship between body mass index (BMI) with patient-reported symptom severity and interference during treatment.
Method
Between May 1, 2017 and December 7, 2018, patients with mNSCLC at a single institution were enrolled in a real-world Advanced Non-Small Cell Lung Holistic Registry (ANCHoR) and completed the MDASI-LC prior to start of therapy and at routine clinic visits. MDASI-LC consists of 16 symptom severity and 6 symptom interference items rated on 0-10 scales (0 = no symptom or interference, 10 = worst imaginable symptom or complete interference). BMI was measured at the same schedule as MDASI-LC. Mixed-effects models were used to examine the longitudinal association between BMI and symptom levels during treatment.
Result
103 patients completed the MDASI-LC prior to start of therapy and at least 2 follow-up assessments. Mean patient age was 64.3 years (standard deviation = 11.5) and 50% were males. 22% of patients received chemotherapy (CTX), 34% immunotherapy (IM), 23% CTX+IM or angiogenesis inhibitor, and 20% targeted therapy. The median pre-treatment BMI was 25.2 (inter quartile range, 5.2). BMI did not change during treatment and no significant difference was found among treatment groups. Compared with the obese group (BMI≥30), the overweight group (25≤BMI<30) experienced lowest levels of fatigue (estimation(est)=-1.23, standard error (SE)=0.49, p=0.016), disturbed sleep (est=-1.66, SE=0.49, p=0.002), distress (est=-0.90, SE=0.40, p=0.030) and less interference on mood (est=-1.03, SE=0.46, p=0.030) and interference with walking (est=-1.50, SE=0.51, p=0.005). The normal group (BMI<25) demonstrated lower levels of fatigue (est=-1.05, standard error (SE)=0.47, p=0.032) and disturbed sleep (est=-1.15, SE=0.47, p=0.018), compared with the obese group.
Conclusion
For patients with mNSCLC, obesity was related with higher symptom burden during active treatment. This analysis provides pilot data for future studies on balanced weight control and patients’ wellbeing during cancer treatment.
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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: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-04 - Single-Port Video-Assisted Thoracoscopic Surgery Reduces Patient-Reported Symptom Burden in Patients Undergoing Lung Resection (Now Available) (ID 2547)
10:15 - 18:15 | Author(s): Qiuling Shi
- Abstract
Background
Symptom relief has been considered one of the most important targets in recovery from a surgery. This study aimed to evaluate the advantages of single-port video-assisted thoracoscopic surgery (VATS) in reducing postoperative symptom burden, by comparison with multi-port VATS in patients undergoing lung resection.
Method
Data were collected from an ongoing, real-world, multicenter, prospective, observational study initiated in November 2017 (NCT03341377). The MD Anderson Symptom Inventory for lung cancer (MDASI-LC) was administered to assess the severity of postoperative symptoms and their interference with daily functioning preoperatively and daily postoperatively until discharge. A symptom burden index (MDASI-SI) was generated by averaging the top 5 severe symptoms. MDASI-SI was compared between groups using the Wilcoxon rank sum test. The changes of symptoms over hospitalization were compared using mixed modeling.
Result
Among 175 patients who underwent lung resection, 89 underwent single-port VATS, 30 two-port VATS, 13 three-port VATS, and 43 four-port VATS. We combined two- and three-port VATS patients due to the small sample size. The top 5 severe symptoms were pain, fatigue, coughing, disturbed sleep, and shortness of breath for all the patients. There were no significant differences between single-, two/three-, and four-port VATS in preoperative MDASI-SI. The median postoperative hospital stay was 6 days for each group. The MDASI-SI scores of single-port VATS (median=3.6; inter quartile range (IQR)=2.4) were significantly lower than those of two/three-port (median=4.6; IQR=2.8; P=0.043) and four-port VATS (median=5.1; IQR=3.3; P=0.0005) on postoperative day (POD) 1. Compared to four-port VATS, patients who underwent single-port VATS experienced significantly lower symptom burden from POD 1 to POD 6 (estimate=-0.77; SE=0.28; P=0.005).
Conclusion
This study provided real-world evidence that the single-port VATS has a significant benefit of reducing symptom burden in patients undergoing lung resection during the early postoperative period. The long-term benefit and its impact on patient’s quality of life, adjuvant therapy, and survival need to be investigated in further studies.
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P2.16-35 - Factors Associated with Prolonged Postoperative Hospital Stay in Patients Undergoing Lung Cancer Surgery (ID 2489)
10:15 - 18:15 | Author(s): Qiuling Shi
- Abstract
Background
It is important to focus on the risk factors associated with prolonged postoperative hospital stay (PHS) as they can significantly increase medical costs. The study aimed to identify independent risk factors of prolonged PHS in patients who underwent lung cancer surgery.
Method
Data were collected from an ongoing, real-world, multicenter, prospective, observational study (NCT03341377). Inclusion criteria were age 18 years and older, no cognitive impairment and ability to understand the study requirements, pathological primary lung cancer diagnosis, and scheduled surgical procedure. Prolonged PHS was defined as hospitalization for more than 7 days after a lung cancer surgery. Logistic regression was used to identify risk factors of prolonged PHS.
Result
A total of 192 patients (117 males and 75 females) who underwent lung cancer surgery were included. The median PHS was 7 days (range, 2–46 days). Among 192 patients, 64 (33.3%) had prolonged PHS. Among those with PHS, 73.4% were males and patients with a smoking history accounted for 60.9%, Charlson Comorbidity Index scores of >1 for 57.8%, tumor located in the upper lobe for 64.1%, open surgery for 57.8%, lobectomy for 64.1%, systematic lymphadenectomy for 57.8%, and tumor stage ≥Ⅱ accounted for 59.4%. The overall in-hospital complication rate was 25%. The most common complication was prolonged air leak. The multivariate analysis revealed that the surgical approach (open vs. video-assisted thoracoscopic surgery) (OR 2.65, 95% CI 1.05-6.67; P=0.039) and in-hospital complications (no vs. yes) (OR 0.15, 95% CI 0.06-0.35; P<0.001) were independent risk factors of prolonged PHS.
Conclusion
Prolonged PHS is still very common in the real world. Open surgery and in-hospital complications were the two main reasons of prolonged PHS in patients who underwent lung cancer surgery. Further studies with a larger sample size are warranted to confirm our results.
