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Clarissa Baldotto
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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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FP02.06 - Implementation of a Lung Cancer Value-Based Care Framework in a Low and Middle-Income Country Institution (ID 3338)
00:00 - 00:00 | Presenting Author(s): Clarissa Baldotto
- Abstract
Introduction
Assessment of the value of lung cancer treatment, and the performance of institutions delivering care is critical, especially in low and middle-income countries, with limited resources. To fully implement measures that support a value-based approach, cancer care institutions must comply with real-world registries with standardized outcomes. Herein, we present the first report of a prospective study to assess non-small cell lung cancer (NSCLC) patient-centered outcomes based on the International Consortium for Health Outcome Measurements (ICHOM) standard set.
Methods
This is a prospective, observational study of NSCLC patients treated at a nationwide private cancer care institution in Brazil between July 2014 and December 2019. The EORTC QLQ-C30 and QLQ-LC13 questionnaires were applied at established time points to analyze the disease burden on patients’ health status, serial changes throughout treatment, and prognostic impact.
Results
This first report comprises 337 patients, from a single institution; most patients were males (57.0%), white (64.7%), and smokers (81.3%). Adenocarcinoma was the most prevalent histological subtype (70.9%), and most patients presented with advanced disease (stages III/IV in 80.7%). Chemotherapy was recommended in 276 patient cases (81.9%), targeted therapy in 49 patients (14.6%), and immunotherapy in only 113 (33.5%). Median OS was 22.2 months (95% CI, 15.8-28.8), and 2-year OS for stages III and IV were 53.4% and 28.0%, respectively. EORTC QLQ-LC13 and QLQ-C30 questionnaires were responded by 333 (98%) and 290 (86%) patients at baseline, and by 225 (67%) and 192 (57%) at third evaluation. Advanced stage was associated with higher symptom burden - fatigue (p=0.03), pain (p<0.001), arm pain (p=0.022) - and worse global, social, and physical functioning (all p<0.001). Males (p<0.001), with older age (p<0.001) and more comorbidities (p<0.001) had higher emotional scores. Upon serial comparisons of quality of life (QoL) parameters during the first 2 years, most factors evolved to either improvement or stability. Cough (p=0.02), pain (p=0.002), global (p<0.001), and emotional (p<0.001) functioning showed significant improvement over time. Staging (p<0.001) and fatigue (p=0.001) were independently associated with OS.
Conclusion
Our results demonstrate the feasibility of a prospective lung cancer registry based on an international standardized dataset focused on patient-reported outcomes. QoL parameters impacted on NSCLC outcomes and can be a tool to align care delivery, increasing access and quality of cancer care across different institutions in low and middle-income countries.
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P18 - Locoregional and Oligometastatic Disease - Misc. Topics (ID 128)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P18.06 - Retrospective Epidemiological Study of Locally Advanced Non-Small Cell Lung Cancer Patients in Brazil – RELANCE (LACOG 0118) (ID 2892)
00:00 - 00:00 | Author(s): Clarissa Baldotto
- Abstract
Introduction
Lung cancer represents an important public health problem in Brazil. Despite suboptimal registry, it is estimated that lung cancer accounted for 28,220 new cases in Brazil in 2016. Nonetheless, there is limited data regarding stage distribution, patterns of treatment and outcomes of NSCLC in Brazil. Around 20-35% of NSCLC patients have stage III at diagnosis. Due to its heterogeneous nature, patients can be amenable to different therapeutic strategies such as upfront surgery, chemoradiation, systemic treatment or palliative care only. Importantly, multidisciplinary team discussion and planning of treatment impacts patients’ outcomes. Little information is available on how stage III NSCLC is treated in clinical practice in Brazil. The RELANCE study aims to capture real world data on stage III NSCLC and to identify possible gaps to achieve optimal treatment for this population in Brazil.
Methods
LACOG 0118 RELANCE is a large multi-institutional study that will collect information regarding sociodemographic data, diagnostic tests, treatment and outcome of patients diagnosed with locally advanced (clinical stage IIIA, IIIB and IIIC) NSCLC in Brazil in the period of January 2015 to June 2019.
Socio-demographic characteristics, clinicopathological features, treatment patterns and outcomes will be extracted from medical charts. Disease status and survival data will be collected up to the last date of follow-up June 2021.
Primary endpoint is to describe overall survival (OS) of locally advanced stage III NSCLC in Brazil. Descriptive analysis of treatments and outcomes are planned. Multivariate analysis will be used in order to identify prognostic factors for survival using the Cox regression. The expected target sample size is 400 patients with locally advanced NSCLC.
Results
As of 25th July, 42 patients have been included, all of them within 6 Brazilians sites. Currently, there are 6 sites awaiting regulatory approval to start enrollment. Recruitment is planned to last until December 2020 when the estimated sample size will be achieved.
Conclusion
LACOG 0118 RELANCE study is one of the largest patient registry that will evaluate current clinical practice for stage III NSCLC in Brazil. The study will describe potential gaps to optimal treatment and demographic and socioeconomic factors associated with patient outcome.
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P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P19.09 - Lung Stereotatic Body Radiation Therapy: Outcomes from a Brazilian Cohort (ID 3747)
00:00 - 00:00 | Author(s): Clarissa Baldotto
- Abstract
Introduction
Stereotactic body radiation therapy (SBRT) has emerged as an excellent treatment option for patients with primary non-small-cell lung cancer (NSCLC), with initial stages and oligometastatic disease. There are few reports in the literature describing “real world” data in a Latin America cohort. Here in we report SBRT lung cancer experience of a single institution in Brazil.
Methods
This is a retrospective analysis of patients that received lung SBRT between 2016 and 2019, in a single Brazilian institution. All patients received SBRT treatment with VMAT (Volumetric Modulated Arc Therapy), with 4d-CBCT (Cone Bean CT - Simetry®). We report local control (LC) per SBRT target, regional or distant failure-free survival, and overall survival (OS) per patient, using Kaplan-Meier estimates.
Results
This report comprises 271 patients with a median follow up of 18 months (range, 6 to 96 months), 74% of patients were men (n=200), median age 62 years (range, 37 - 98); Primary lesions (n = 136) were histology Adenocarcinoma (n = 85; 63%), Squamous Carcinoma (n = 43; 32%) and Neuroendocrine (n = 6; 5%); For secondary lesions (n = 135), 63% (n = 84) were Lung Cancer, 11% (n = 15) Gastro Intestinal Tumors, 10% (n = 13) Breast Cancer and 16% (n = 24) Other types. A median of five fractions (range, 3 to 10 fractions) and a total median dose of 59 Gy (range, 54 to 62 Gy) per lesion were prescribed for primary tumors. For secondary lesions, a median of five fractions (range, 3 to 10) and a total median dose of 45 Gy (range 30 to 62Gy). The 3 – Year Local Control for all patients was 89.14%, 93.48 (Primary) and 76.8% (Secondary) The 2-year rates of overal survival, for all patients was 67%, 88.2% (Primary) and 48.8% (Secondary), respectively. Grade 3 to 4 toxicities were observed in seven patients (3.8%): grade 3 pneumonitis (n = 5), grade 3 esophagitis (n = 1), and fatal hemoptysis (n = 1).
Conclusion
SBRT is effective and provide good local control, overall survival and low toxicity results in a real world scenario in Latin America. The results are in line with data published elsewhere.
