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Mohana Roy
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MA10 - Assessing and Managing Supportive Care Needs (ID 215)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 1/31/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA10.06 - Healthcare Utilization with an Electronic Patient Reported Outcome (ePRO) tool for Symptom Management in Thoracic Cancers (ID 2020)
11:45 - 12:45 | Presenting Author(s): Mohana Roy
- Abstract
Introduction
Electronic patient Reported Outcomes (ePROs) have been associated with improved symptom management and quality of life in patients with advanced cancer, along with reported decreases in emergency department (ED) use (Basch et al. JCO 2016). However, there are limited follow up studies showing the impact of the implementation of ePROs on healthcare utilization.
Methods
We conducted a randomized clinical trial of an ePRO application compared with standard of care (SOC), in patients with advanced cancer at Stanford Cancer Institute. Here, we report the trends of healthcare utilization in the thoracic cancer subgroup (n=18 in ePRO and n=19 in SOC arms). We assessed baseline demographics, technology use and quality of life. Retrospective chart review assessed points of contact with the thoracic oncology clinic, including telephone and patient portal encounters. We also assessed whether messages and phone calls were related to symptom management, with two reviewers.
Results
37 of 49 patients were assessed, with patients excluded if they did not complete follow up questionnaires. At baseline, 83% of the ePRO patients and 91% of the SOC patients noted using smartphone applications more than once a day. Overall healthcare utilization did not increase with the ePRO, with similar median number of phone calls and electronic patient generated messages (Table 1). We did not note a significant difference between calls or messages related to symptoms as well.
Pre-During-and Post-Trial Healthcare Utilization
(Median (Interquartile Range))
Phone Encounters
6 months prior to trial
6 months on trial
6 months post-trial
ePRO
2 (0.25-3.75)
2 (0-2.75)
0 (0-3)
SOC
1 (0-2)
2 (1-3)
2 (0.5-3)
Phone Encounters related to Symptoms
6 months prior to trial
6 months on trial
6 months post- trial
ePRO
1 (0-3)
0 (0-2)
0 (0-1)
SOC
1 (0-1.5)
2 (0-2)
2 (2-2)
Patient Electronic Portal Messages
6 months prior to trial
6 months on trial
6 months post- trial
ePRO
2 (1-8.25)
5 (3-7)
4 (2.25-10.5)
SOC
2 (1-5.5)
6 (2.5-11)
5 (1.5-13.5)
Patient Electronic Portal Messages related to Symptoms
6 months prior to trial
6 months on trial
6 months post-trial
ePRO
1 (0-2)
2 (0.25-3.75)
2 (0.35-6)
SOC
1 (0-2)
3 (1.5-7.5)
3 (1-7)
Conclusion
Use of an ePRO platform for symptom reporting in advanced thoracic malignancies was feasible at an academic medical center. While there is concern surrounding ePROs increasing staff workload, we did not notice an increase in overall and symptom related phone calls and electronic patient portal messages. Future directions include analysis from different disease groups and expansion to a second academic center to further understand this tool’s impact on healthcare utilization.
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P35 - Pathology - Genomics (ID 105)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P35.19 - The Mutational Landscape in South Asian Patients with Non-Small Cell Lung Cancer at an US Academic Medical Center (ID 1943)
00:00 - 00:00 | Presenting Author(s): Mohana Roy
- Abstract
Introduction
Various molecular underpinnings of lung cancer have been noted in Asian populations, especially with targetable mutations such as EGFR and ALK (Doval et al., Ann Oncol 2014). However, the distribution and prevalance of these mutations have been less well characterized in South Asian/Indian patients, especially those who live outside of South Asia.
Methods
We performed a retrospective review of NSCLC cases from 2005-2019, at Stanford Cancer Center, USA,, and identified seventy-two patients who had a South Asian name. Their ethnicity was confirmed with manual review, with inclusion of patients noting origin from India, Pakistan, Bangladesh, or Sri Lanka. Patients were excluded if they did not have a confirmation of their ethnicity in the electronic medical record. Molecular testing data and type of methodology used for testing was also collected.
Results
72 patients were identified from 2005-2019, of which 63 patients had mutational testing (from 2009-2019) performed. Of the 9 patients who had no mutational testing, 7/9 had non metastatic disease. Demographics and testing characteristics are shown in Table 1. 35 of 63 patients had targetable mutations (55.6%), with 21 patients with EGFR activating mutations (exon 19 deletion or exon 21 L858R) (33.3% of 63 patients).. Other mutations included 8 ALK rearrangements (12.7%), 6 KRAS mutations (9.5%), 2 ROS1 fusions (3.1%), and 2 BRAF V600E mutations (3.1%) (Figure 1). In assessing co-mutations, 3 ARID1A and 3 STK11 mutations were noted.
Table 1
N= 72
Female
37 (51%)
Median age of diagnosis, years (range)
64 (38-89)
Non-Smoker
62 (86%)
Country of Origin/Ethnicity
India- 68 (94%)
Pakistan- 3 (4%)
Bangladesh-1 (1%)
Pathology
Adenocarcinoma- 63 (88%)
Adenocarcinoma with Mixed Features- 4 (6%)
Squamous (4%)
Stage of Disease
I or II- 12 (17%)
I or II with recurrence- 7 (10%)
III- 7 (10%)
III with recurrence-1 (1%)
IV-45 (63%)
Type of Testing
Fluorescence in situ hybridization (FISH) only – 3 (4%)
Next Generation Sequencing (NGS)- 34 (47%)
Polymerase Chain Reaction (PCR) (includes ddPCR)- 27 (37.5%)
Conclusion
South Asian patients, largely of Indian origin, with NSCLC at an US academic center appear to have a high chance of harboring a driver mutation, emphasizing the importance of molecular testing in this population. These findings corroborate rates of mutations reported from South Asia, and suggest similar trends in mutation prevalance despite different geographical locations. We are collaborating with an institution in Northern India to further compare and report on the molecular landscape of this population.
