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Alexa Meara



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    MA24 - Initiatives to Improve Health in Lung Cancer Patients (ID 354)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Advocacy
    • Presentations: 1
    • Now Available
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      MA24.03 - Factors Impacting Patients’ Worries (Accessing Treatment, Treatment Toxicity, & Emotional Burden) Associated with Lung Cancer Treatments (Now Available) (ID 2589)

      14:30 - 16:00  |  Author(s): Alexa Meara

      • Abstract
      • Presentation
      • Slides

      Background

      Understanding patient experiences with lung cancer can guide research, treatment, and policy decisions. Conducted as part of a larger study (Project Transform) that aimed to quantified patient experiences, we sought to study the primary concerns of lung cancer patients and their caregivers and to determine what demographic and clinical factors impact these worries.

      Method

      Lung-cancer worries were identified from patient interviews and the literature. A novel an instrument assessing 13 potential worries on a 3-point importance scale was incorporated as part a national survey of lung cancer patients (inclusive of all types/stages of disease) and caregivers recruited through LUNGevity Foundation. Factor analyses was used to identify key constructs among the 13 worries. We then explored variation in the standardized factor scores across demographic and clinical indicators collected in the survey.

      Result

      Of the 426 participants in the survey, there were 385 patients and 41 caregivers. The average age of respondents was 58.9 years, 54% earned less than $75,000 per year, and 67.6% had completed college. Three factors were identified associated with worrying: 1) “accessing treatments” (incorporating knowledge, communication, access); 2) “treatment toxicity” (incorporating both side-effects and financial impact); and 3) “emotional burden” (including worries about dying, emotional toll, and being a burden), with Cronbach’s alphas of 0.89, 0.73, and 0.74 respectively. Worries about accessing treatment were lower among NSCLC (P=0.006), presence of MET mutations (P = 0.027) and those not currently receiving therapy (P=0.033). Worries about treatment toxicity were higher among non-white (P<0.001), non-retired (P<0.001), those earning less than $75,000 (P<0.001), younger patients (P<0.001), and those with ALK (P=0.026) or HER2 (P=0.041) mutations. Worries about treatment toxicity were lower among patients on Medicare or Medicaid during treatment (P = 0.023) and NSCLC patients (P=0.018). Worries about the emotional burden of treatment were lower among those >=60 years (P=0.002) and those who are retired (P=0.021) and higher among those having surgery (P=0.039).

      Table 1: Marginal effects of patient factors on standardized worry scores

      Factor

      Accessing Treatment

      Treatment toxicity

      Emotional burden

      Patient

      -0.052 (0.16)

      -0.144 (0.16)

      -0.224 (0.16)

      Age >= 60

      -0.1 (0.1)

      -0.336 (0.1)***

      -0.309 (0.1)**

      Female

      0.003 (0.12)

      0.239 (0.12)

      0.158 (0.12)

      Non-white

      -0.022 (0.16)

      0.56 (0.16)***

      0.048 (0.16)

      Hispanic, Latino, or Spanish

      -0.003 (0.22)

      0.233 (0.22)

      0.161 (0.21)

      Primary Language - Spanish

      0.116 (0.7)

      0.879 (0.69)

      0.423 (0.67)

      Armed Forces

      -0.103 (0.18)

      -0.134 (0.18)

      0.055 (0.18)

      Marries

      0.139 (0.11)

      -0.177 (0.11)

      0.073 (0.11)

      Has children

      0.004 (0.13)

      -0.031 (0.13)

      0.203 (0.12)

      College or professional degree

      0.208 (0.11)

      -0.096 (0.11)

      -0.104 (0.1)

      Retired

      -0.048 (0.1)

      -0.488 (0.1)***

      -0.233 (0.1)*

      Household Income < $75,000

      0.031 (0.11)

      0.376 (0.11)***

      0.025 (0.11)

      Population < 2,500

      -0.168 (0.22)

      -0.099 (0.22)

      0.193 (0.21)

      Chronic conditions as diagnosis

      -0.078 (0.12)

      -0.021 (0.12)

      0.146 (0.12)

      NSCLC

      -0.308 (0.11)**

      -0.263 (0.11)*

      -0.111 (0.11)

      Private Insurance

      0.084 (0.11)

      0.139 (0.11)

      0.057 (0.11)

      Medicare or Medicaid

      0.02 (0.1)

      -0.235 (0.1)*

      -0.079 (0.1)

      Other Insurance

      -0.092 (0.17)

      -0.144 (0.17)

      -0.128 (0.17)

      No Insurance

      0.363 (0.58)

      0.56 (0.58)

      -0.083 (0.58)

      Participated in a clinical trial

      -0.029 (0.12)

      -0.134 (0.12)

      0.077 (0.12)

      ALK

      0.143 (0.14)

      0.295 (0.13)*

      0.041 (0.12)

      BRAF

      -0.241 (0.56)

      -0.663 (0.55)

      -0.345 (0.52)

      EGFR

      -0.038 (0.13)

      -0.109 (0.13)

      0.121 (0.12)

      HER2

      0.689 (0.48)

      0.973 (0.47)*

      0.439 (0.45)

      KRAS

      -0.201 (0.21)

      -0.067 (0.21)

      -0.113 (0.2)

      MET

      -0.765 (0.34)*

      -0.389 (0.34)

      0.19 (0.32)

      NTRK

      0.767 (0.68)

      0.467 (0.67)

      0.101 (0.63)

      RET

      0.154 (0.4)

      -0.47 (0.39)

      -0.69 (0.36)

      ROS1

      0.149 (0.26)

      -0.053 (0.25)

      0.202 (0.24)

      More than 2 lines of treatment

      0.09 (0.1)

      0.026 (0.1)

      0.03 (0.1)

      Chemotherapy

      0.019 (0.16)

      0.008 (0.16)

      0.007 (0.16)

      Radiation

      0.197 (0.29)

      0.339 (0.3)

      0.101 (0.3)

      Targeted therapy

      0.143 (0.1)

      0.038 (0.1)

      0.129 (0.1)

      Immunotherapy

      0.124 (0.18)

      0.188 (0.19)

      -0.125 (0.19)

      Surgery

      0.454 (0.29)

      0.407 (0.3)

      0.612 (0.29)*

      Angiogenesis inhibitors

      0.081 (0.41)

      0.101 (0.42)

      0.268 (0.42)

      No current treatment

      -0.214 (0.1)*

      -0.192 (0.1)

      -0.163 (0.1)

      Notes: Standard errors in parentheses, * p<0.05, ** p<0.01, ***p<0.001

      Conclusion

      Conclusion:

      Patients worry to differing extents about accessing treatment, treatment toxicity, and the emotional burden of lung cancer, yet caregivers and patients (on the whole) have similar worries. Lung cancer researchers, clinicians, and policymakers should make decisions in ways that address the heterogeneous experience of patients. Patients worries vary across a confluence of demographic, disease, and treatment factors, hence greater attention to the individual needs of the patient is needed.

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