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Li C. Liu



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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): Li C. Liu

      • Abstract
      • Slides

      Background

      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.

      Method

      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,

      Result

      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).

      Conclusion

      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  |  Author(s): Li C. Liu

      • Abstract

      Background

      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.

      Method

      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.

      Result

      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).

      Conclusion

      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%

      Total

      USPSTF criteria -ve

      231

      (59.8%)

      [94.7%]

      155

      (40.2%)

      [29.5%]

      386

      (100.0%)

      [50.1%]

      USPSTF criteria +ve

      13

      (3.4%)

      [5.3%]

      371

      (96.6%)

      [70.5%]

      384

      (100.0%)

      [49.9%]

      Total

      244

      (31.7%)

      [100.0%)

      526

      (68.3%)

      [100.0%]

      770

      (100.0%)

      [100.0%]

      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%

      Total

      USPSTF criteria -ve

      102

      (49.5%)

      [97.1%]

      104

      (50.5%)

      [33.1%]

      206

      (100.0%)

      [49.2%]

      USPSTF criteria +ve

      3

      (1.4%)

      [2.9%]

      210

      (98.6%)

      [66.9%]

      213

      (100.0%)

      [50.8%]

      Total

      105

      (25.1%)

      [100.0%)

      314

      (74.9%)

      [100.0%]

      419

      (100.0%)

      [100.0%]