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Gail Darling
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FP02 - Health Services Research/Health Economics (ID 120)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP02.10 - Predictors of Moderate-to-Severe Symptoms in Stage IV NSCLC: A Population-Based Study of Patient Reported Outcomes (ID 3525)
00:00 - 00:00 | Author(s): Gail Darling
- Abstract
- Presentation
Introduction
Patients with metastatic NSCLC have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC.
Methods
Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, socioeconomic factors, and cumulative cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms.
Results
Of the 22,799 stage IV NSCLC patients identified, 13,593 (59.6%) had at least 1 completed ESAS recorded (87,791 unique assessments) in the year following diagnosis. Majority (94.6%) reported at least 1 moderate-to-severe score. Tiredness (peak: 67.4%, overall: 84.3%), lack of wellbeing (peak: 62.1%, overall: 80.9%), low appetite (peak: 50.4%, overall: 72.1%), and shortness of breath (peak: 51.0%, overall: 68.1%) were the most prevalent moderate-to-severe symptoms reported by patients within 12 months after diagnosis (these peaked at diagnosis), while nausea (34.92%) was the least common.
Conclusion
Patients receiving chemotherapy alone (17.5%, n= 2,380), radiotherapy alone (36.3%, n=4,936), or both (24.8%, n=3,369) reported more moderate-to-severe symptoms compared to patients receiving no treatment (risk ratio [RR]: 1.04, 1.04, and 1.06 respectively [all p-values<0.0001). Receiving chemotherapy alone or chemotherapy and radiotherapy combinations was associated with score≥4 in all individual ESAS domains (p-values <0.05), while receiving radiotherapy alone was associated with score≥4 in all domains but shortness of breath (RR: 0.98, p=0.26). Immigrants and patients with worst socioeconomic deprivation index were less likely to report moderate-to-severe symptoms.
Moderate-to-severe symptoms were prevalent throughout the first year following stage IV NSCLC diagnosis at the population-level. Patients receiving chemotherapy and/or radiotherapy were at increased risk of moderate-to-severe symptoms and may require more supportive care. Further analyses on predictors of severe-to-moderate score on each ESAS domain will be discussed in the presentation.
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P36 - Pathology - Prognosis (ID 106)
- 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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P36.04 - Molecular Prognostic Factors in Neuroendocrine Thymic Tumors: a Retrospective Multicentre Study (ID 1899)
00:00 - 00:00 | Author(s): Gail Darling
- Abstract
Introduction
Thymic neuroendocrine tumor(TNET) is a rare group of heteroplastic lesions with a poor outcome. The TNET encompasses a variety of neoplasms that have in common histologic, immunohistochemical, and, occasionally, clinical features of neuroendocrine function. The present study aims to analyze whether a prognostic factor of a panel of twenty renowned biomolecular markers may contribute to shed some light upon the pathogenesis of this dreadful disease.
Methods
We retrospectively evaluated TNET clinical data and reviewed pathological tissue samples collected from patients of two Institutional Thoracic Surgery Units. All patients were divided into three groups according to histological diagnosis: typical carcinoid(TC), atypical carcinoid(AC), and mixed(MxTNET). Twenty biomolecular markers, adopted in previously worldwide published papers, were utilized in a tissue microarray parallel in situ analyses. The χ2 test or Fisher’s test and the Kruskal Wallis test were used to analyze categorical and continuous variables, respectively. Overall and disease-free survival analysis was performed with the Kaplan-Meier method and the log-rank test. The cut off value of the markers was detected with the ROC curves, the Youden index, and the associated criterion. P-values < 0.05 were considered significant.
Results
From January 1994 to December 2012, a total of 20 patients was outlined from the databases[see table].
The overall survival was significant for pMTor (p=0.004) as well as at the disease-free survival analysis (p=0.002). Moreover, a significant trend was seen, at the disease-free survival analysis, towards two molecules such as Osteopontin (p=0.032) and PTEN (p=0.023). Hash-1 was identified as statistically significant (p=0.025) in the AC group compare to TC and MxTNET[see graphs].
Conclusion
Thymic neuroendocrine tumors with a highly expressed pTEN and Osteopontin can be a negative prognostic factor. Lymph nodal dissection should be always performed during the surgical procedure to prevent possible relapses of the disease. The increased risk of progression warrants an accurate and lifelong follow-up.
