Virtual Library

Start Your Search

Neil Bayman



Author of

  • +

    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
    • +

      MA19.09 - Assessing Clinical Frailty in Advanced Lung Cancer Patients - An Opportunity to Improve Patient Outcomes? (Now Available) (ID 2363)

      11:30 - 13:00  |  Author(s): Neil Bayman

      • Abstract
      • Presentation
      • Slides

      Background

      The median age of non-small cell lung cancer (NSCLC) diagnosis in England is 73 years. At that age, 40% of the general population has some degree of clinical frailty which may impact survival, quality of life, anti-cancer treatment tolerability and access to clinical trials. However, clinical frailty is often not addressed or managed at the time of anti-cancer treatments. This project was designed to integrate frailty assessments and build frailty pathways within an advanced cancer care setting in order to better support patients and improve outcomes.

      Method

      This quality improvement project that used Plan-Do-Study-Act (PDSA) methodology. Phase one of the project focused on establishing a multidisciplinary team to integrate a frailty screening tool, the Rockwood Clinical Frailty Scale (CFS), into standard clinical practice. The primary aim was to implement and screen ≥80% of all new lung cancer patients at a high-volume tertiary cancer centre. The secondary aim was to explore the correlation of CFS with age, performance status (PS), treatment selection and systemic anti-cancer treatment (SACT) tolerability. Specialised training was provided to the clinical team and the CFS was integrated from 26/11/2018 on an electronic form routinely completed by clinicians. A digital dashboard was set-up to monitor real-time data and the frail group was defined as CFS score >3. Data cut-off for this analysis was 29-03-2019.

      Result

      335 lung cancer patients were screened using CSF by a team of 20 clinicians with a compliance rate of 89%. There was a strong correlation between PS and CFS (r= 0.77, p<0.01). The distribution of both CFS and PS correlated with ageing (r= 0.2 and r= 0.17, respectively; p<0.01). Patients ≥70 years were more likely to be frail (56% vs 40%; OR 1.4, 95%CI 1.2-1.7; p<0.01). Frailty reduced the likelihood of receiving any anti-cancer treatment by 20%. Amongst those who started SACT, patients classed as frail were less likely to go beyond the first cycle of treatment (64% vs 91%; OR 0.7, 95%CI 0.5-0.9; p<0.01).

      Conclusion

      CFS screening is feasible within a busy clinical practice when incorporated as a digital tool. CFS helps to identify patients who may potentially benefit from specialised frailty assessment and management. This could ultimately be used to better inform on treatment selection, and support requirements during treatment, to improve outcomes for patients in the future.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P2.08 - Oligometastatic NSCLC (ID 172)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.08-02 - Outcomes Following Stereotactic Radiosurgery for Syncronous Brain Metastases in Non-Small Cell Lung Cancer (ID 426)

      10:15 - 18:15  |  Author(s): Neil Bayman

      • Abstract
      • Slides

      Background

      Approximately 10% of non-small cell lung cancer (NSCLC) patients have brain metastases at presentation. The use of stereotactic radiosurgery (SRS) has enabled a proportion of patients with oligometastatic brain disease to be offered a radical treatment in conjunction with SRS. We evaluated the outcomes for patients presenting with synchronous brain metastases who received SRS to determine if radical treatment improves survival.

      Method

      164 patients with NSCLC received SRS for brain metastases between January 2012 and December 2017. This analysis focused on 71 patients who presented synchronously with brain metastases. Electronic patient records were accessed in March 2019 to determine initial extracranial disease treatment and date of death or last follow up.

      Result

      30 patients received radical treatment (18 radiotherapy alone, 11 chemo-radiotherapy and one surgery) and 24 received palliative treatment (17 chemotherapy, four radiotherapy and three tyrosine kinase inhibitor). 17 patients received no treatment following SRS, either due to death, deterioration in performance status or patient choice. Baseline demographics are presented in table 1.

      table 1.jpg

      Median overall survival for the radical, palliative and no treatment groups were; 7.9 (95% CI 5.5-14.0), 9.4 (6.6-14.4) and 1.4 (1.0-2.9) months, respectively. There was no significant difference in survival between the radical and palliative groups (p=0.43). Kaplan-Meier survival estimates at 12 and 24 months were 30.0% (95% CI 17.4- 51.8%) and 10.0% (3.4-29.3%) for the radical and 33.3% (18.9- 58.7%) and 13.0% (4.1-41.4%) in the palliative group, respectively.

      Conclusion

      Our results did not demonstrate the benefit for radical treatment, as expected based on published data. Potential reasons for this result include a lack of tools to select patients for radical treatment. Prospective studies are needed to identify the optimal treatment for extracranial disease in this patient group.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    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
    • +

      P2.17-02 - Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy (ID 291)

      10:15 - 18:15  |  Author(s): Neil Bayman

      • Abstract
      • Slides

      Background

      International guidelines currently recommend radical radiotherapy for non-small cell lung cancer (NSCLC) patients with ECOG performance status (PS)0-2. Despite a paucity of evidence for treating poorer PS patients, modern advances have allowed patients with PS3 to be offered radical radiotherapy.

      Method

      PS0-3 NSCLC patients receiving radical radiotherapy at The Christie Hospital, UK between August 2016-October 2017 were retrospectively identified from hospital electronic patient records. Survival was calculated from date of first oncology review to November 2018. Baseline and treatment characteristics for PS3 patients were recorded including adult comorbidity evaluation (ACE)-27 score, pulmonary function, radiation dose volume parameters and radiotherapy regimen (i.e stereotactic ablative radiotherapy (SABR) vs standard radiotherapy (50-55Gy/20 fractions)).

      Result

      504 patients were identified: 440(87%) PS0-2 and 64(13%) PS3. Six PS3 patients withdrew themselves; four before treatment and two after one fraction. Of 58/64(91%) PS3 patients completing radiotherapy, 43(74%), 4(7%), 10(17%) and 1(2%) were Stage I, II, III and IV at diagnosis, respectively. ACE-27 score was 0, 1, 2 and 3 in 3(5%), 8(14%), 16(28%) and 31(53%) patients, respectively. 31(53%) received SABR and 27(47%) standard radiotherapy. On intention-to-treat analysis, there was no significant difference in survival over 18 months in PS3 patients compared to PS0-2; p=0.858 (Fig.1). There was no significant difference in survival among PS3 patients completing radiotherapy when stratifying by stage(I vs II vs III) (p=0.343), ACE-27 score(1 vs 2 vs 3)(p=0.266), or radiotherapy regimen(p=0.655). Lung function tests(FEV1, FVC) and radiotherapy dose volume parameters(PTV, V5, V10,V20) failed to predict survival of PS3 patients at 6, 12 and 18 months.

      nsclc rb.png

      Conclusion

      This study demonstrates that PS3 patients receiving radical radiotherapy had a similar 18-month survival compared to PS0-2 patients and baseline and treatment characteristics did not predict overall survival in PS3 patients. This suggests more PS3 patients could be considered for radical radiotherapy and further studies with larger cohorts are recommended.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.