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Rob Stirling
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EP1.05 - Interventional Diagnostics/Pulmonology (ID 195)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.05-07 - Examining Endobronchial Ultrasound (EBUS) Utilisation in Lung Cancer Diagnosis and Treatment Delay. A Restrospective Observational Study (Now Available) (ID 2933)
08:00 - 18:00 | Presenting Author(s): Rob Stirling
- Abstract
Background
Introduction
• EBUS has high diagnostic yield in the assessment of mediastinal lymphadenopathy, staging and diagnosis of lung cancer. (1)
• FDG PET/CT scans can be used in the initial assessment of hilar and mediastinal nodes, EBUS-TBNA has a higher sensitivity and specificity for staging these lymph nodes in patients with lung cancer. (2)
• The provision of high quality EBUS demands that procedures are delivered in a manner which is demonstrably evidence based, effective, equitable, safe, patient-centred and timely.
• Timeliness in EBUS provision will ensure a minimum in patient related anxiety and minimal prolongation of the referral to diagnosis and referral to treatment intervals.
Objective
To examine the impact of EBUS wait time on diagnosis and treatment delay in evaluating lung cancer and mediastinal lymphadenopathy within the Alfred Hospital.
Method
Method
A retrospective chart review of diagnosed lung cancer patients undergoing EBUS (linear and radial) at the Alfred Hospital between August 2013 and September 2018 was conducted. We recorded the waiting interval between EBUS referral and procedure and examined impact on lung cancer management timeliness from lung cancer referral to lung cancer diagnosis and first treatment based on electronic records. Electronic records were also used to gather baseline patient characteristics.
Result
103 EBUS procedures were completed on 96 patients with the below characteristics.
Lung cancer referral to diagnosis interval had mean 23.2 days (30.5 SD), diagnosis to treatment interval had mean 24.1 days (21.2 SD), and referral to treatment interval had mean 47.4 days (35.9 SD).
EBUS within one week of EBUS referral, n(%)
70 (79%)
EBUS within two weeks of EBUS referral, n(%)
85 (96%)
EBUS waiting time was compared for lung cancer referral to diagnosis interval (within vs delay of greater than 28 days), and diagnosis to treatment interval (within vs delay of more than 14 days). There was a trend towards diagnosis delay with prolonged wait for EBUS (p=0.052). Significantly, EBUS wait time was greater for delayed referral to treatment interval (more than 42 days), than within 42 days (p=0.012).
Conclusion
Delay in investigation has the potential to delay key management issues including lung cancer diagnosis and treatment. Prolonged wait for EBUS lead to a trend towards diagnosis delay and significant delay in referral to treatment interval in this cohort. Further assessment of causes in EBUS delay warrants further investigation.
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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
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EP1.11-23 - Protocol for a Randomized Controlled Trial of FDG-PET-CT in Follow Up of Stage II-IIIA NSCLC Post Treatment (Now Available) (ID 2946)
08:00 - 18:00 | Presenting Author(s): Rob Stirling
- Abstract
Background
Early stage Non-Small Cell Lung Cancer (NSCLC) accounts for some 70% of all lung cancer and, although curative treatment may be an option, the 5 year survival remains poor at just over 50%. If cancer recurrence or new disease following initial treatment could be detected earlier, especially whilst still asymptomatic, overall survival may be improved by enabling the earlier use of modern effective salvage therapies. Currently, there is limited evidence, and no consensus in Australia or internationally, on the most effective surveillance strategy following curative treatment. Hence, there is a critical need for a prospective study to examine whether a modern approach to surveillance imaging with PET-CT to detect NSCLC recurrence or new disease earlier and whilst still asymptomatic will not only improve survival but is cost effective.
Method
We propose a randomised controlled trial of systematic PET-CT for follow up of patients treated with curative intent for stage II-IIIA NSCLC at hospitals across Australia. Patients will be randomised to either usual care or systematic PET-CT 6 monthly over 3 years and followed for 5 years. Patients with new or recurrent disease will be referred for treatment to their usual clinical team and treatment details collected. The primary outcome of this study will be overall survival. Secondary outcomes include, 1. Detection rate for new tumours and a/symptomatic recurrence 2. Number/type of investigations used in the control arm. 3. Number/type of investigations used in the evaluation of new problems. 4. False positive/negative detection rate. 5. Cost effectiveness analysis. 6. Patient experience. Study design is a 2 arm trial with 1:1 randomisation to routine PET-CT surveillance added to usual care (or usual care alone), commencing 6 months after surgery or curative radiotherapy. The study will be stratified by centre, stage, curative therapy and ongoing smoking status.
Result
Section not applicable
Conclusion
The study results will define for each stage of disease, whether active surveillance with PET-CT added to usual care prolongs survival compared to usual care. It will also allow for collection of real-word data to understand of what constitutes usual care such that the mortality from the commonest cause of cancer death in our community.
