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Maria Teresa Ruiz Tsukazan



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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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      P09.38 - 2020: COVID19 Impact in Lung Cancer Resection in a University Hospital of Brazil (ID 3815)

      00:00 - 00:00  |  Author(s): Maria Teresa Ruiz Tsukazan

      • Abstract
      • Slides

      Introduction

      Lung cancer remains the leading cause of cancer mortality globally. Low survival rate is related with diagnosis in advanced stages. Treatment of choice for early stages is surgery. Delaying surgical treatment in larger tumor sizes or suspicious N1 lymph nodes can result in upstaging and consequently poorer prognosis. COVID19 interfered with elective medical care, reducing number of patients referred for thoracic surgeons. We wanted to analyze the COVID19 pandemic impact in the number of patients that had lung cancer resection.

      Methods

      Hospital São Lucas da PUCRS has a prospective database. Patients that had lung cancer resection from January 2019 to July 2020 were compared to January 2020 to July 2020. Lobectomy, pneumonectomy and segmentectomy were included. Descriptive and proportions test were used for analysis of type of resection and healthcare insurance.

      Results

      For 2019, 37 resections were performed compared to 17 (p=0.006) in 2020. Mean age was 63.7 years in 2019 and 60.2 in 2020. Number of men was 22 (59.5%) and 8 (47.1%) in 2019 and 2020, respective. The reduction of lobectomies was 42.1 % (p=0.14), from 19 to 11 surgeries. For segmentectomies a reduction of 77.8% (p=0.003), from 18 to 4 surgeries. The only two pneumonectomies were performed in 2020. Reduction was identified for public health care system (42.8%, p=0.4): 20% for lobectomies (10 to 8) and 72.7% (11 to 3 in 2020). For supplemental health care (private and insurance), overall reduction of 68.7% (from 16 to 5 p=0.02) 66.7% (9 in 2019 and 3 in 2020) lobectomies and 85.7% (7 to 1 surgery in 2020) segmentectomies. March and April had a 70% reduction (10 to 3 surgeries)

      Conclusion

      Overall lung resection reduction during COVID19 pandemic happened as expected. Significant reduction in number of patients that had surgery in supplemental health care, especially in the months related for the state intensive social distance and restrictions. For the for public health care, the reduction of total numbers of procedures and type of resections was not significant. This is probably related to the fact the schedule of medical appointment and surgery is organized by the system and can’t be postponed by the patient.

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    P12 - Health Services Research/Health Economics - Health Policy (ID 124)

    • 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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      P12.03 - Public Versus Private Care Patients Treated in the Same Hospital. Are the Patients the Same? (ID 1439)

      00:00 - 00:00  |  Presenting Author(s): Maria Teresa Ruiz Tsukazan

      • Abstract
      • Slides

      Introduction

      In Brazil around 75% of population relies on public health care system. Most of patients that have their lung cancer diagnosis at stage IV. Our academic hospital serves both public and private patients. We wanted to evaluate surgical patients if there were difference in the profile, tumor size, in hospital mortality in a developing country.

      Methods

      Retrospective analysis of patients from public and private healthcare system that underwent lobectomy from January 2013 to December 2018 at a single center. Comparison of surgical approach, tumor size, number of lymph nodes stations and in hospital mortality were analyzed using chi square test or Fisher exact test. Wilcoxon two-sample t test was used for comparison of means.

      Results

      A total of 257 lobectomies were performed in our hospital. After excluding benign diseases (48), lobectomies for metastatic diseases (6) and missing data (9) we had 194 patients in our analysis. The mean age was 65.1 yo (29-84), females 50.5% (98), public healthcare system 71.1% (138), VATS approach 8.2% (16), right upper lobectomy 37.1% (72), mean tumor size 3.2 cm, pathological N0 77.8% (151), mean number of lymph nodes stations of 4.4 and more than 3 lymph nodes stations removed in 81.4% (158) and in hospital mortality 3.1% (6).

      Table 1 – Characteristics of the patients for public and private healthcare system – n(%) or mean (SD).

      Public(N=138) Private (N=56) p
      Age (mean) 64.5 (9.34) 66.6(11.23) 0.141
      Female (%) 64 (46.4) 34 (60.7) 0.082
      VATS approach (%) 0 (0) 16 (28.6) <0.001
      Lobectomy (%) 0.906
      Right Upper Lobe 51 (37) 21 (37.5)
      Right Middle Lobe 15 (10.9) 7 (12.5)
      Right Lower Lobe 25 (18.1) 8 (14.3)
      Left Upper Lobe 26 (18.8) 13 (23.2)
      Left Lower Lobe 21 (15.2) 7 (12.5)
      Tumor size (cm) (SD) 3.32 (1.94) 2.9 (1.97) 0.160
      Lymph Node (%) 0.047
      pN0 101 (73.2) 50 (89.3)
      pN1 21 (15.2) 4 (7.1)
      pN2 16 (11.6) 2 (3.5)
      Number of lymph node stations removed (mean) 4.4 (2.19) 4.2 (2.20) 0.678
      In Hospital Mortality (%) 6 (3.6) 1 (1.8) 0.674

      Conclusion

      Primary lung cancer patients treated in the same hospital, irrespectively of the healthcare system, had similar number of lymph nodes stations removed and in hospital mortality that are proxy quality of care. We found significant difference in the type of surgery approach that can be justified by the extra cost of material not available for public healthcare. Another significant difference was the distribution of N1 and N2 disease that might be related of later lung cancer diagnosis and access in public healthcare.

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    P52 - Staging - Prognosis and Staging (ID 186)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Staging
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P52.02 - Staging Lung Cancer: Are All Suspicious Lymph Nodes Pathologic? (ID 3802)

      00:00 - 00:00  |  Presenting Author(s): Maria Teresa Ruiz Tsukazan

      • Abstract
      • Slides

      Introduction

      Introduction: Lymph node status is a key component of staging. If a lymph node is pathologic, the patient is at least a stage IIB (for N1) or more advanced according to the lymph node location. Accurate staging is important for the patient in order to receive the best care and determines if is surgical, systemic, or multimodal. However, image can be false positive, especially in an endemic granulomatous disease’s country as Brazil.

      Methods

      Thoracic surgery department of Hospital Sao Lucas da PUCRS actively prospectively contributes for the Brazilian Society of Thoracic Surgeons database. All patients with primary lung cancer that were resected between January 2015 and December 2019 were included. Clinical and pathological lymph nodes status were analyzed using proportion test with SAS.

      Results

      Of 710 patients, 340 (47.9%) had lung cancer, 219 (30.8%) had lung resection and 161 (22.7%) had inclusions criteria. Sample had 86 (53.4%) women, average age of 65.8 years, adenocarcinoma in 113 (73.4%), lobectomy in 144 (89.4%), pre-operative mediastinal invasive staging in 93 (57.8%), video-assisted thoracic surgery im 24 (14.9%). Overall, we identified upstaging in 20 (12.2%) patients (p<0.001), 8 (6.3%) from cN0 to pN1, 10 (7.9%) from cN0 to pN2 and 2 (15.3%) from cN1 to pN2. Downstaging was observed in 22 (64.7%) of patients that had suspicious lymph node in either PET-CT or CT (p<0.086). From cN1 to pN0 there were 6 (46.2%) patients and 16 (80%) from cN2 to pN1. Out of total of 20 patients with cN2 and, 16 (80%) had downstaging (p<0.001).

      Picture1. Clinical and Pathologic Staging Outcomes

      picture1. clinical and pathologic staging outcomes.jpg

      Conclusion

      Overall upstaging was 12.2% and cN2 downstaging was 80% reinforcing the importance of invasive mediastinal staging in a country with high incidence of granulomatous disease.

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