Virtual Library
Start Your Search
Biniam Kidane
Author of
-
+
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
-
+
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): Biniam Kidane
- 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.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
MA03 - New and Revisited Prognostic Factors in Early Stage Lung Cancer (ID 119)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 15:30 - 16:30, Scientific Program Auditorium
-
+
MA03.06 - Health-Related Quality of Life in Lung Cancer Patients Undergoing Thoracic Surgery (ID 3356)
15:30 - 16:30 | Author(s): Biniam Kidane
- Abstract
- Presentation
Introduction
Health-related quality of life (HRQOL) of patients undergoing lung cancer surgery is affected by multiple factors and may serve as a prognostic factor. A knowledge gap exists regarding whether certain patients may benefit from targeted pre-treatment interventions to improve HRQOL and clinical outcomes. The objective of this study was to determine the trajectory of HRQOL in the perioperative period and whether pre-operative HRQOL is associated with post-operative complications.
Methods
A retrospective cohort study was performed using prospectively-collected data. Consecutive patients seen at a tertiary thoracic centre between January 2018-January 2019 underwent longitudinal assessment of HRQOL using self-reported Euroqol-5 Dimension Three Level (EQ-5D-3L). Post-operative complications were assessed using the Ottawa Thoracic Morbidity & Mortality System, prospectively with double-adjudication. Comorbidities were assessed prospectively using Charlson Comorbidity Index. Mean EQ-5D-3L scores were examined over multiple clinic visits and analyzed using repeated-measures ANOVA. Multivariable logistic regression was used to determine the independent association between pre-treatment EQ-5D-3L scores and incidence of post-operative complications.
Results
Of 1648 patients seen for consults during the study period, 515 (31.3%) proceeded to surgery. 225 (43.7%) surgeries were for lung cancer. Of patients undergoing lung cancer resection, 72 (32.0%) experienced at least one complication. 190 (84.4%) lung cancer surgeries were minimally invasive. The trajectory of patients’ mean EQ-5D-3L visual analogue scale (VAS) scores did not change significantly between clinic visits (p > 0.1). The majority of patients experienced moderate-higher pain/discomfort EQ-5D-3L descriptive scale scores. Half of patients experienced moderate-higher deficits in EQ-5D-3L scores for usual activities by third and fourth clinic visits; this likely represents the transient post-operative decline, which surprisingly does not affect all patients universally. The majority of patients experienced no deficits in mobility, self-care, and anxiety/depression. Lower pre-treatment EQ-5D-3L VAS scores were not associated with post-operative complications (p = 0.8). Higher pre-treatment pain/discomfort score was independently associated with increased risk for complications (adjusted odds ratio of 2.0 [95% CI 1.03-3.89, p = 0.04]) despite adjustment for surgery type.
Figure. Patients’ EQ-5D descriptive scale scores over multiple clinic visits: A) Mobility B) Anxiety/depression C) Pain/discomfort D) Usual activities E) Self-care.
Conclusion
Pre-treatment HRQOL appears to be associated with post-operative complications in patients undergoing lung cancer resection. Pre-operative HRQOL assessments could be used to identify patients who are at higher risk for complications, thereby facilitating targeted interventions to improve perioperative outcomes. Specifically, interventions that target pain/discomfort pre-emptively may be beneficial. The effect of these interventions could be tracked by longitudinal HRQOL.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
P62 - Tumor Biology and Systems Biology - Basic and Translational Science - Metabolomics (ID 200)
- Event: WCLC 2020
- Type: Posters
- Track: Tumor Biology and Systems Biology - Basic and Translational Science
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P62.04 - Metabolic Profile of Urine of Early Stage Non Small Cell Lung Cancer Patients Before and After Surgical Resection Using Mass Spectrometry (ID 1072)
00:00 - 00:00 | Author(s): Biniam Kidane
- Abstract
Introduction
Despite curative resection of early-stage Non-Small Cell Lung Cancer (NSCLC), many patients can experience recurrence and are thus subjected to surveillance with repeated imaging tests. We aimed to understand the cellular metabolic processes involved in tumor initiation, progression, and metastasis. We hypothesized that non-invasive monitoring of urinary metabolites would allow the detection of metabolic changes in response to treatment and can thereafter be used for surveillance of recurrence. Our current study aimed to assess the changes in urinary metabolites in response to surgical removal of the tumor.
Methods
In this prospective cohort study, urine was collected before and after surgical resection from patients with early-stage NSCLC. It was analyzed for a change in their metabolic profile using Liquid chromatography Quadrupole Time-of-Flight Mass Spectrometry (LC-QTOF-MS). Patients with biopsy-proven NSCLC, a PET-avid pulmonary nodule, or an enlarging nodule on serial CT scans of the chest with clinical stage I/II eligible for resection were prospectively enrolled. Mid-stream urine was collected pre-operatively and within four months post-operatively. Metabolic data was acquired on a 1260 Infinity HPLC coupled to a 6538 UHD Accurate Q-TOF MS system equipped with an electrospray ionization source. Surgical pathology for each patient was reviewed, and only patients with confirmed NSCLC were included for analysis. Fold change was assessed with paired T-tests (P<0.05; ≥ 2-fold changes) employing an asymptotic P-value and multiple testing correction (Benjamini-Hochberg). Mass Professional Profiler software was used to identify urinary metabolites of statistical significance, and their up/down regulation was recorded. This was further confirmed with mass spectra, retention time, and confidence scores against the Metlin database containing >79,000 metabolites, 39,000 lipids, and 168,000 peptides.
Results
Thirty-six patients with clinical stage I/II pathologically-confirmed NSCLC who provided urine samples before and after surgical resection were analysed. Mean age was 64.9 years (SD=7.4). There were 22 females (61.1%) and 14 males (38.9%). Smoking history was as follows: current smokers (n=10), ex-smoker or never smoked (n=20), no history available (n=6). Six patients had diabetes and 17 patients had COPD. Distribution of histology was: adenocarcinoma (n=29), squamous cell cancer (n=5), and other (n=2). Mean tumor size on pre-operative CT was 2.4 cm (SD=1.6); mean tumor size from pathology specimens was 2.7 cm (SD=1.8). Mean PETSUV was 8.2 (SD=6.4).
Twenty-nine urinary metabolic compounds were significantly different between their pre-surgery and post-surgery levels. Twenty-one compounds were over-expressed before surgical resection with a significant decline after resection. 8/29 compounds were significantly elevated after resection. Notably Proline-Leucine was significantly over expressed at pre surgery level with the following Log 2 values: pre surgery level of 11.22 vs. post-surgery1.93 (P<0.0001). Asymmetric dimethyl arginine (ADMA) pre surgery level of 8.10 vs. post-surgery 4.12 P=0.044). N6-Methyladenosine was significantly upregulated post-surgical resection with pre surgery level of 3.51 vs. 8.25 (P=0.0085).
Conclusion
Testing of urinary metabolites showed that Proline-Leucine over-expression pre-operatively was significantly reduced after removal of lung cancer. Proline, glutamic acid- and leucine-rich protein-1 has been found to be associated with NSCLC. Our study has identified a non-invasive potential panel of biomarkers for NSCLC and requires larger clinical studies for confirmation.
