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Susan Harden
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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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FP02.05 - Value-Based Healthcare Study (VBHC) for Treating Lung Cancer in Victoria, Australia (ID 3782)
00:00 - 00:00 | Presenting Author(s): Susan Harden
- Abstract
Introduction
Value in healthcare can be defined as the degree of quality of care received as a function of the cost of delivering care. Value of care has never been formally measured for lung cancer. To our knowledge, there are no publications defining value in lung cancer from either the point of view of consumer, health service, government or funder. Any definition of value must however incorporate quality, service and cost.
Lung cancer is the leading cancer burden in Australia, and the leading cause of cancer-related death. Population health efforts target prevention, screening and detection of early, potentially curable lung cancer, delivery of curative and palliative treatments to optimally manage lung cancer. Recently, targeted biologic and immunotherapeutics have demonstrated substantial benefit but also attach substantial economic implications. With each initiative to improve lung cancer outcomes, there is an urgent need to understand the cost, quality and value returned to patients and funding bodies to inform patients, providers and governments. This study was designed to address this universal problem.
Methods
A cohort of 200 people diagnosed with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) over 4 months from 1 November 2020 will be identified at Lung Multidisciplinary meetings (MDMs) at 5 participating Victorian health services and data collected from the Victorian Lung Cancer Registry:
1.Quality indicators and clinical outcome measures stratified by stage, including proportions i) referred for smoking cessation; ii) receiving MDM discussion prior to definitive treatment; iii) stage I-III receiving treatment with curative intent (surgery/radical radiotherapy, multimodality treatment); iv) NSCLC receiving molecular testing, v) early palliative care referral, vi) emergency admissions, vii) screened for supportive care needs, viii) 1 year overall survival, ix) hospital readmissions for treatment related complications.
2.Patient Reported Measures collected at multiple timepoints including EORTC QLQ-C30, QLQ-LC29, QLU-C10D, a patient experience survey at diagnosis and at 12 months incorporating value-based priorities.
3.Consumer Focus Groupscto explore patient perceptions of quality and value with regard to care; utility and acceptability of study methods and consumer value rankings for treatments and outcomes by stage of disease.
4.Health service costs for diagnostic procedures and treatments to establish cost and cost variation for stage specific treatment, based on optimal treatment guidelines.
Conclusion
A Value scorecard will be derived establishing a baseline VBHC model for lung cancer treatment in Victoria, aiming to identify stage-specific interventions to increase relative value for lung cancer care.
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MA04 - Health Policy and the Real World (ID 217)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 16:45 - 17:45, Scientific Program Auditorium
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MA04.09 - Impacts of Multidisciplinary Meeting Presentation: Drivers and Outcomes from a Population Registry Retrospective Cohort Study (ID 2037)
16:45 - 17:45 | Author(s): Susan Harden
- Abstract
- Presentation
Introduction
Evaluation of lung cancer is complex and discussion in a multidisciplinary context is recommended. The benefits of Multidisciplinary Meeting (MDM) presentation have been demonstrated in case series however its population-based impacts demand evaluation. We evaluated the drivers, likelihood of receipt of treatment and survival impacts of MDM presentation in the population-based Victorian Lung Cancer Registry (VLCR).
Methods
Patients in the VLCR (Non-Small Cell and Small Cell Lung Cancer), prospectively captured following diagnosis between 2011 to 2020, were categorised as MDM-presented or non-presented based on medical record documentation. The association of patient, disease and hospital characteristics with likelihood of MDM discussion was determined via logistic regression. Median survival was compared using Kaplan-Meier method and mortality risk was assessed using cox-regression modelling. Propensity score matching, landmark analysis (excluding deaths within 6 weeks of diagnosis), and sensitivity analyses with interaction terms were performed to evaluate these results.
Results
Of 9,628 patients, 5,900 (61.3%) were discussed at MDM, 3,728 (38.7%) were not. Patients in the non-MDM group were more likely to be ≥80 years old (p<0.001), with poorer performance status (p<0.001) and advanced stage at diagnosis (43.4% vs. 34.0% clinical stage IV, p<0.001). Non-MDM patients were less likely to undergo surgery (22.1 vs 31.2%, p<0.001), chemotherapy (44.7 vs 49.0%, p<0.001) or radiotherapy (34.2 vs 44.4%, p<0.001). They were less likely to be referred from a sub-acute vs acute facility (p<0.001), private vs public hospital (p<0.001) or inner regional vs major city hospital (p<0.001).
Patients were less likely to be presented at MDM if clinical stage IV (OR 0.34, p<0.001), referred from an inner regional (OR 0.52, p<0.001), subacute facility (OR 0.57, p<0.001) or private hospital (OR 0.18, p<0.001)
MDM-presented patients overall had better median survival (1.70 vs 0.75 years, p<0.001) and a 25% reduced overall mortality risk (HR 0.75 (0.71 to 0.80), p<0.001), MDM presentation was strongly associated with receipt of treatment (surgery 0.30 (0.27-0.33), p<0.001; chemotherapy 0.55 (0.52-0.59) p<0.001; radiotherapy 0.88 (0.83-0.93) <0.001). This protective effect was confirmed on propensity score analyses and consistent across hospital types and locations. Factors associated with a higher mortality were age >80 years (HR 1.63, p>0.001), male gender (HR 1.17, p<0.001), ECOG 4 (HR 6.04, p<0.001), clinical stage IV (HR 6.55, p<0.001) and referral from subacute hospital (HR 1.60, p<0.001).
Non-documentation of ECOG status, tumour histopathology and clinical stage were associated with significantly lower likelihoods of MDM discussion (OR 0.34, 0.35, 0.29 respectively, p<0.001) and higher mortality (HR 1.51, 1.34 and 2.90 respectively, p<0.001).
Conclusion
In this population-based lung cancer registry, being male, ≥80 years of age, of high ECOG, advanced clinical stage and poor documentation of clinical characteristics were associated with lower likelihood of MDM discussion, lower likelihood of treatment and a higher mortality risk. MDM presentation conferred survival benefit in lung cancer across all hospital types and locations. This study supports the use of MDM presentation as a crucial component of lung cancer management and identifies patient subgroups where discrepancies in care exist and urgent action is needed.
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.22 - Curative Intent Treatment for Small Cell Lung Cancer in England (ID 3783)
00:00 - 00:00 | Presenting Author(s): Susan Harden
- Abstract
Introduction
Overall survival for small-cell lung cancer (SCLC) is poor with many patients presenting with metastatic disease. However, for patients with limited stage I–III disease and good performance status (PS), treatment with curative intent should be delivered. Concurrent chemo-radiotherapy (cCTRT) is the standard of care, recently confirmed by the CONVERT trial, with NICE guidelines also suggesting consideration of surgery for stage I SCLC. This study investigates changes in practice for SCLC treatment and extent of implementation of the CONVERT trial in England
Methods
Patients in England diagnosed with stage I–III SCLC from 1 January 2017 to 31 December 2018 were identified from the National Lung Cancer Audit (NLCA) 2018 and 2019 annual report datasets, comprising data collated, maintained and quality assured by the National Cancer Registration and Analysis Service (NCRAS), including the radiotherapy dataset (RTDS) and systemic anti-cancer therapy (SACT) dataset. Radical radiotherapy (rRT) was defined as a total dose of 40Gy or more. cCTRT was defined as delivery of radical radiotherapy commencing during (or within 7 days prior to) first-line SACT.
Results
In total there were 7833 cases of SCLC and 28.4% (2222/7833) were diagnosed with stage I–III disease; 81% (1797/2222) were documented as being of good performance status, ECOG PS 0-2.
Overall, multi-modality treatment (SACT in combination with either rRT or surgery) was given to 37% cases (816/2222), 42% of cases with documented PS 0-2. In total, 60% of all stage I-III SCLC patients received either palliative or no active treatment, 55% for people with PS 0–2. Treatments received are summarised in Table 1.
For those cases receving chemotherapy and rRT with complete treatment dates available, over the two year period 47% were treated with cCTRT rather than sequentially. However the proportion treated concurrently increased from 44% to 52% over the two years.
When cCTRT was delivered, 44% of radical RT was prescribed in accordance with the CONVERT trial (35% 45Gy/30# bd and 9% 66Gy/33#), with 31% receiving 40Gy/15#. Concurrent cisplatin etoposide was used for 49% cases, with 47% receiving carboplatin etoposide.
Conclusion
Curative intent multi-modality treatment was given to 37% I–III SCLC patients in England (42% of those with PS0-2). When cCTRT was delivered, the gold standard cCTRT Turrisi regimen of 45Gy/30# was used in 35% patients. Whilst use of cCTRT is increasing, more than half of cases with PS0-2 stage I-III SCLC received either palliative or no active treatment during this two year period.
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P25 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Mesothelioma Preclinical, Prognostic and Predictive Factors (ID 139)
- Event: WCLC 2020
- Type: Posters
- Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P25.08 - National Organisational Audit of Specialist Mesothelioma Service and Support Provision for the United Kingdom (ID 3793)
00:00 - 00:00 | Presenting Author(s): Susan Harden
- Abstract
Introduction
The UK has the highest worldwide incidence of mesothelioma. Rapid access to appropriate diagnostics, active treatments and supportive care, preferably at a local hospital, are important to patients and carers. However, as a rare cancer, it is recognised that some specialist services for mesothelioma may not be available locally, requiring clear pathways to access services at a regional level. The mesothelioma organisational audit, funded by Mesothelioma UK, was designed to obtain an accurate picture of mesothelioma services across the UK, and to identify and address variation in access to specialist services and treatment for mesothelioma patients.
Methods
All clinical leads of thoracic cancer services were contacted at the 174 hospital providers across the UK and invited to complete an online survey covering how mesothelioma patients were diagnosed, discussed and treated locally. Participants were also asked whether patients were referred on to a tertiary or regional specialist mesothelioma MDT.
The clinical leads for the identified specialist mesothelioma MDTs were then invited to complete a further online survey and telephone interview covering the specialist services they offered.
Results
125(72%) out of 174 hospital providers participated in the organisational audit across England, Wales, Scotland and Northern Ireland.
17 providers were identified as specialist mesothelioma MDT services discussing over 25 mesothelioma cases per year, with the largest MDT discussing over 200 cases per year.
14/17 mesothelioma MDTs meet on a weekly basis with 4/17 held entirely separately to the weekly lung MDT and 7/17 reflecting the regional nature of their service within their MDT name. 12/17 Mesothelioma MDTs discuss 5 or less cases per 30 minute meeting; however up to 20 cases are discussed per meeting lasting 60-90 minutes at several busy surgical centres.
7/17 mesothelioma MDTs have a mesothelioma MDT specific referral proforma and 5/17 of mesothelioma MDTs regularly discuss referrals from outside their region or cancer alliance. 12/17 MDTs report that they restage all discussed cases and 11/17 review all histology slides. All 17 MDTs report MDT outcomes back to the referring provider by MDT proforma, or by email.
All 17 mesothelioma MDTs required core attendance by a chest physician, surgeon, radiologist, pathologist, oncologist and specialist nurse, with 9/17 (53%) having a mesothelioma-specific nurse specialist present at the mesothelioma MDT. 4/17 mesothelioma MDTs had regular palliative care attendance and 5/17 used routine teleconferencing.
All 17 specialist mesothelioma MDTs have access to diagnostic surgical services and oncologic treatments. 16/17 are aware of the national peritoneal mesothelioma MDT at Basingstoke and 12/17 have made referrals to it. 15/17 (88%) of mesothelioma MDTs have mesothelioma trials open at their centre with all 17 MDTs referring patients on to surgical centres participating in the MARS2 trial for radical debulking surgery or for mesothelioma trials open at other centres.
Conclusion
This first organisational audit identifies that whilst there is no standardisation of specialist mesothelioma MDT services across the country, there are common themes of good practice in the 17 self-identified specialist centres, in particular access and entry into mesothelioma trials and support from mesothelioma specialist nurses.
