Virtual Library
Start Your Search
Paul Wheatley-Price
Author of
-
+
EP1.11 - Screening and Early Detection (ID 201)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
-
+
EP1.11-01 - Lung Cancer Screening and Canada’s Inuit: A Missed Opportunity (Now Available) (ID 447)
08:00 - 18:00 | Author(s): Paul Wheatley-Price
- Abstract
Background
Inuit peoples account for 0.2% of Canada’s population. Lung cancer rates in this population are disproportionately high for both genders with Canada’s Inuit having the highest incidence of lung cancer in the world. Outcomes are also poor with median survival for all stages combined in Nunavut being approximately 10 months.
Lung cancer screening with low dose CT scan is being implemented in many countries, and a pilot program exists in Ontario, Canada. However, the screening model may not be appropriate for the Inuit.
Method
A literature review was performed regarding lung cancer screening, specifically with reference to the Inuit.
Result
Several challenges must be considered for implementation of lung cancer screening with the Inuit population.
The Prostate, Lung, Colorectal and Ovarian Screening Trial model (PLCO[M2012]) is the risk prediction model used in the Ontario Lung Cancer Screening Pilot for People at High Risk. This requires individuals to be between ages 55-74 and to have smoked daily for at least 20 years during their life. The average life expectancy among Inuit is 72 years, compared to 82 years for Canadians overall. Using this model where the average life expectancy is lower than the upper limit of eligibility restricts its applicability.
Smoking rates among this indigenous group are approximately 3 times higher than the rest of Canada, which indicates a clear need for screening where a higher proportion of the population would be eligible.
Nunavut is a vast land area of around 2 million square kilometres, with a population of approximately 35,000. The logistics of providing screening in remote communities only connected by air travel is therefore daunting.
Other dominant health issues among the Inuit of Nunavut are high rates of tuberculosis, therefore screening CT scans may be further complicated by higher false positive scans requiring established algorithms for management of all abnormal scans.
With the Inuit population growing faster than the rest of Canada, yet experiencing a reduced lifespan as compared to other Canadians, there is an opportunity to address the inequity that may be created with the current eligibility model used for screening in Ontario. Furthermore, current recruitment strategies and eligibility assessments are not well suited to this group’s unique background.
Conclusion
The current PLCO risk prediction model used in Ontario may not offer the best benefit for screening in this population while careful thought about how this group is recruited is also required to minimize barriers experienced by this vulnerable population.
-
+
MA22 - Partnering with Patients to Understand Stigma, Disparities and Values Leading to Improved Lung Cancer Care (ID 154)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Advocacy
- Presentations: 1
- Now Available
- Moderators:Diego Villalón, Christina Sit
- Coordinates: 9/09/2019, 15:45 - 17:15, Amsterdam (2011)
-
+
MA22.07 - A Culturally Safe Advocacy Model of Care for Inuit Cancer Patients and Their Families (Now Available) (ID 448)
15:45 - 17:15 | Author(s): Paul Wheatley-Price
- Abstract
- Presentation
Background
The Ottawa Hospital is the tertiary care center for Inuit living in the Baffin Island region of Nunavut, in Canada’s far North. Inuit – once relatively cancer free – now have among the highest lung cancer rates in the world (Young et al., 2016). Approximately 30% of Inuit diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016), for which they must travel thousands of kilometers where they are displaced from family, community and culture.
Colonization has had a detrimental impact on the social determinants of health for Inuit in Nunavut and has created a lack of trust in government institutions. This context creates an advocacy need at the individual and systems level to address access and equity issues, with the goal of advancing positive health outcomes.
Method
The Champlain Indigenous Cancer Program (CICP) team has developed a patient-centered, culturally appropriate, land-based approach to support Inuit patients using the principles of the “Supportive Care Framework” (Fitch, 1994) as a guiding ideology. Recognizing the social and economic inequities (Inuit Tapiriit Kanatami, 2019), the Nurse Navigator developed an unconventional approach to connect with Inuit patients. She prioritizes developing therapeutic, trusting relationships with patients and families based on the observation that Inuit patients often feel most comfortable outside the confines of a hospital office. Developing these relationships on the land has become a cornerstone of her work.
Result
The approach that the CICP has implemented has achieved far-reaching success. Between the first six months and latest six months of tracking (through 2017-2018) there has been a 400%+ increase in patient encounters with the Nurse Navigator role. Clinicians report an increased awareness and understanding of the unique context of Inuit patients and families, resulting in increased numbers of referrals to CICP. Within the Inuit community, there is a recognition and appreciation of the Inuit-specific approach, leading to an increase in self-referrals.
Conclusion
The CICP is continuing to actively pursue tracking and reporting initiatives to demonstrate a shift in access to cancer care and the long-term outcomes for Inuit patients and families. The program is also continuing to increase access to cultural awareness education for staff to combat misunderstandings about Inuit. By sharing experiences and stories garnered through this work, the Nurse Navigator will help attendees to question and redefine the perception of the traditional role of a cancer nurse.
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.
-
+
MA24 - Initiatives to Improve Health in Lung Cancer Patients (ID 354)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Advocacy
- Presentations: 1
- Now Available
- Moderators:Merel N. Mountain, Nicoleta Mitrea
- Coordinates: 9/10/2019, 14:30 - 16:00, Melbourne (1991)
-
+
MA24.02 - Developing Regional Activity for a National Charity: The Lung Cancer Canada Experience (Now Available) (ID 962)
14:30 - 16:00 | Presenting Author(s): Paul Wheatley-Price
- Abstract
- Presentation
Background
Lung Cancer Canada (LCC) is the only national charity solely committed to the most common cancer in Canada. Its mission is to raise awareness; to advocate; and to provide support and educational resources for lung cancer patients and caregivers. At a strategic planning event the LCC Board held in 2017, the goal of building regional hubs was identified - to deliver the charities mandate within local contexts.
Method
A group of key stakeholders (patients, caregivers, fundraisers, social workers, nurses and physicians) met to identify local priorities. Specific programs were developed, with other initiatives flowing from that initial effort. Here we describe the group's achievements.
Result
From the initial stakeholder meeting two prime opportunities were identified.
1. Create a support group for women with lung cancer.
2. Take advantage of being in the national capital to more purposefully engage with Federal politicians.
In addition to the stakeholder meeting, subsequent social gatherings of key individuals helped build momentum.
Through partnership with a local charity (Ottawa Regional Cancer Foundation), marketing through LCC, recruitment through the cancer centre, and program development from a senior psychosocial oncology social worker, the support group was formed for an initial 12 week period, and has now grown to an established permanent fixture. The benefits have been previously reported, but out of this group further local initiatives have included: regular patient-led lung cancer information sessions in the cancer centre; a regional patient summit for all lung cancer patients to learn latest research, patient testimonies and psychosocial challenges; the funding and initiation of an LCC podcast series.
Concurrently more individuals and families have become engaged in fundraising for lung cancer: events including quiz nights, makeovers, golf days, wine raffles and more, which in addition to raising funds also builds awareness and builds the local community.
These individuals have partnered with physicians to stimulate the second goal, initiating regular meetings with municipal, provincial, federal and senatorial politicians, in addition to military leadership and indigenous groups. This itself helped the national organization to hone the advocacy message we share (lung cancer awareness, lung cancer screening, access to treatments, and the establishment of a national registry).
Conclusion
Through identification of local champions who effectively work together, many initiatives have successfully developed. With funding and support from LCC, the charity’s mandate is being delivered within the local context. This serves as a model for other centres across Canada to develop local programs.
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.
-
+
P1.01 - Advanced NSCLC (ID 158)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
-
+
P1.01-16 - Evolution of Systemic Therapy Uptake in NSCLC Over Time: The Impact of New Therapies (ID 922)
09:45 - 18:00 | Presenting Author(s): Paul Wheatley-Price
- Abstract
Background
Non-small cell lung cancer remains the most common cancer worldwide, and the leading cause of cancer deaths, partly because half of all patients are diagnosed at stage IV. Due to comorbidities or poor functional status many never receive systemic therapy. In previous research, we reported only 55% of advanced NSCLC patients received systemic therapy between 2009-2012 following out-patient oncology consultation (Brule et al. Lung Cancer 2016). Since then there has been broader emergence of rapid diagnostic assessment pathways, targeted therapies and immunotherapy, so we explored whether treatment rates have increased.
Method
With ethics approval, we reviewed all cases of de novo stage IIIB/IV NSCLC seen in out-patient medical oncology consultation between 10/2015 and 09/2017. Patients treated with curative intent were excluded. The primary endpoint was the proportion of patients who received any line of systemic therapy. Further descriptive analysis looked at rates of targeted therapy and immunotherapy uptake.
Result
In the study period, 461 patients met eligibility for analysis. Of these, 205 (44%) women; 425 (92%) stage IV, 343/82/36 adenocarcinoma/squamous/other. Median age was 69 years. Median time from pathological diagnosis to medical oncology consult was 13 days.
Overall, 286 patients (62%) received at least one line of systemic therapy (155 patients received one line only, 90 received two lines, 34 received three lines and four patients received >=four lines). Among the 175 patients who did not receive any systemic therapy, the most common stated reasons were; poor PS (104, 59%), patient choice (48, 27%) or comorbidities (7, 4%).
From 379 non-squamous NSCLC patients, 314 (83%) had a documented EGFR test (42/245/27 positive/negative/inconclusive) and 339 (89%) had a documented ALK test (12/311/13 positive/negative/inconclusive). Among the 42 EGFR+ patients, 90% received systemic therapy and among the 12 ALK+ patients, 92% received systemic therapy.
For the non-EGFR, non-ALK patients, the proportion who received systemic therapy was 61%. Immunotherapy was prescribed in 87 patients: 3 in first line, 72 in second line and 12 in three+ line.
Conclusion
In our academic centre between 2009-2012 only 55% of patients seen in out-patient oncology consultation received any line of systemic therapy. With more widespread molecular testing and the emergence of immunotherapy this has climbed to 62%. With an increase in first-line immunotherapy and more widespread molecular profiling, this should continue to improve, giving more patients the option of effective therapy.
-
+
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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.16-40 - Acknowledging Social and Economic Inequities Experienced by Canada's Inuit: Implications for Diagnosis and Treatment of Lung Cancer (Now Available) (ID 664)
10:15 - 18:15 | Author(s): Paul Wheatley-Price
- Abstract
Background
The Inuit living in Canada’s north have the highest rates of lung cancer in the world. Barriers to care are numerous and exist at all phases of the lung cancer journey. Beginning with difficulty in accessing the diagnostic phase of care through to treatment at a tertiary cancer centre located over 2000 km away and little to no palliative care available locally, this population experiences obstacles at each step of their lung cancer journey.
The Inuit in Canada’s arctic experience dramatically higher rates of social and economic inequity than the rest of Canada with only one hospital serving a land mass similar to the size of Mexico, access to or from many communities is by air only. This means that diagnosis and treatment for lung cancer is provided thousands of kilometres away from family, community and culture, often for months at a time.
Along with geographic barriers to care, Inuit peoples also have a historical mistrust of government and mainstream health care services owing to past encounters with colonization and marginalization. A lack of awareness of Inuit specific culture from health care providers (i.e. discrimination) further compounds this lack of trust. These end result of these traumas contribute to the significant health disparities experienced by the Inuit as compared to other Canadians and may in part explain why approximately 30% of Inuit diagnosed with lung cancer between 2000-2010 did not access cancer care.
To better meet the needs of this population, TOHCC hired an Indigenous Nurse Navigator in 2016 with a goal to provide culturally safe care for Inuit patients and their families. Collaborative relationships have been built with key stakeholders in Inuit communities through consistent efforts which in turn have garnered awareness of Inuit specific issues within TOHCC and the surrounding city.
Method
In depth semi-structured interviews with Inuit patients, caregivers and community leaders. The Indigenous nurse navigator will interview participants either in person or by video during April and May 2019.
Result
The results of these interviews will be presented at the 2019 World Lung Cancer Conference in Barcelona.
Conclusion
There is still much work to do in breaking down barriers to accessing care at all phases of the lung cancer journey for the Inuit of Canada’s North. This presentation offers the opportunity to hear directly from a marginalized community who potentially have the greatest lung cancer needs of any population in the world.
