Objective improvement in lung cancer patient care by the development of a multidisciplinary clinic (MDC) in the community

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17086-17086
Author(s):  
W. Mayfield ◽  
R. Bordoni ◽  
R. Holder ◽  
M. Waldman ◽  
A. Muster ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Stage Iv ◽  
Cost Effective ◽  
Pulmonary Medicine ◽  
Optimal Care ◽  
Cancer Management ◽  
Cancer Registry Data ◽  
Secondary Endpoints ◽  
Definitive Surgery ◽  
Thoracic Malignancies

17086 Background: Medical resources allocated to lung cancer management are limited, scattered and uncoordinated, resulting in sub-optimal care. The MDC offers patients access to multi-disciplinary care (Pulmonary Medicine, Thoracic Surgery, Medical and Radiation Oncology) to operate in an efficient, cost effective way. Methods: 2004 Cancer Registry data on time to treatment (TTT) for lung cancer was 53 days. A project with the primary endpoint of reducing the TTT from 53 to 30 days was designed. Secondary endpoints were improvement in treatment planning; enhancement in clinical trials referral, and patient satisfaction. On 9/15/05 the MDC open its doors. The project was assigned to this clinic including patients with solitary lung nodules, lung, esophageal, and mediastinal cancers, mesothelioma, and other thoracic malignancies. Results: 54 pts were seen in the first 90 days; median age 60 (range 41–82), 29 males; 32 (59%) lung cancer (94% NSCLC), 8 (15%) esophageal cancer, 6 other diagnosis, and 6 abnormal radiological findings without diagnosis. The TTT of 30 evaluable patients is 26.36 days. Of the 30 NSCLC the TNM stage was: 4 IA, 5 IB, 2 each IIA/IIB, 8 (27%) IIIA, 3 (10%) IIIB, and 6 (20%) IV. Fifteen of the cases had pathologic staging. Out of 9 pts with cstage I, 7 (78%) had definitive surgery; 4 pts confirmed to have pstage IB, were evaluated for adjuvant chemo. Four pts with cstage II had surgery, 2 of them adjuvant chemo. Of the 11 pts with cstage III, 5 (46%) received concurrent CHRT, 1 (stage IIIA) underwent surgery f/b chemo, 2 received chemo alone and 2 refused therapy. Out of 6 pts with stage IV, 5 (83%) received systemic therapy. Conclusions: The TTT of 26.36 days represents a 50.26% improvement from our institutional benchmark of 53 days. Updated and expanded data on our project primary and secondary endpoints will be presented at the meeting. No significant financial relationships to disclose.

Are the presenting characteristics and prognosis of primary salivary gland-type lung cancers (SG) similar to those of other non-small cell lung cancers (NSCLC)?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7054-7054
Author(s):  
John M. Varlotto ◽  
Suhail M. Ali ◽  
Malcolm M. DeCamp ◽  
John Charles Flickinger ◽  
Abram Recht ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Optimal Care ◽  
Chi Square ◽  
Cancer Specific Survival ◽  
Lung Cancers ◽  
Survival Difference

7054 Background: SG, both adenoid cystic (ACC) and mucoepidermoid (ME) sub-types, are rare lung cancers. We choose to investigate the incidence of these rare sub-types and assess their difference in presentation and prognostic characteristics in comparison to adenocarcinomas (Ad) and squamous cell carcinomas (SCC) during the same time period. Methods: The SEER-17 database was used to collect data during the years 1988-2008. Differences between populations were determined by the chi-square test. Survival curves were generated as Kaplan-Meier techniques. Cox proportional hazards test was used to compare survival differences. Results: During the 20-year study period, ACC (n =100) and ME (n= 178) accounted for 0.03% and 0.06% of NSCLCs. Mean follow-up was 34.5 months for all patients. In comparison to ACC, patients with ME were significantly more likely to be younger (52 yr vs. 60yr), Asian(11.7% vs. 7%), have Stage I disease (62.9% vs 24.0%), and less likely to be in the mainstem bronchi (17.2% vs. 6.3%). In comparison to patients with patients presenting with either SCC or Ad, both ME and ACC were significantly less likely to present with Stage IV disease (26.6% SCC, 41.29% Ad, 16.73% SG), have nodal involvement (35.1% SCC, 27.4% Ad, 23.37% SG), and be older (70 SCC, 68 Ad, 58 years SG). Stratified by stage and treatment, there was no survival (OS) or disease-specific survival difference (DSS) between ACC and ME. The OS of the combined group of ME and ACC was significantly better stage per stage than either Ad (Hazard ratio (HR) range = 0.26- 041), and SCC (HR range = 0.17-0.56). Lung Cancer-Specific survival at 2,3,5 years for surgically-resected Stage I ACC and ME were 83.5%, 80.4%, and 80.4%; and 82.6%, 78.0% and 78%, respectively. Conclusions: Patients with ACC and ME have rare sub-types of lung cancer that present differently and have better survival than patients presenting with either of the more common histologic sub-types (SCC and Ad) of NSCLC. We encourage prospective, multi-institutional studies of these rare sub-types so that care can be optimized. Optimal care may differ for SG because of their stage per stage better prognosis than other NSCLCs.

Study KBP-2010-CPHG: Characteristics and management of 7,051 new cases of lung cancer managed in French general hospitals in 2010.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1574-1574
Author(s):  
Chrystele Locher ◽  
Dominique Herman ◽  
Geoffroy De Faverge ◽  
Hubert Barbieux ◽  
Christine Lemonnier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Epidemiologic Study ◽  
Primary Lung Cancer ◽  
Stage Iv ◽  
Patient Characteristics ◽  
New Drugs ◽  
First Line ◽  
Multi Centre Study ◽  
General Hospitals ◽  
Cancer Management

1574 Background: An initial epidemiologic study was performed in 2000 by the French College of General Hospital Respiratory Physicians (Study KBP-2000-CPHG). Over the last 10 years, lung cancer management changed: new drugs such as targeted therapies appeared; new diagnostic techniques such as exploration for genetic mutations in the tumour have been developed; a new TNM classification has been drawn up. The aims of this study were to describe patient characteristics, first-line management, 1, 4 and 5-year survival rates and to compare the results with those of Study KBP-2000-CPHG. Methods: A prospective multi-centre study included all patients ≥18 years presenting with a new case of primary lung cancer, histologically or cytologically diagnosed between 1 January and 31 December 2010 and managed by one of the participating centers. A standardised form was completed for each patient. A steering committee checked the exhaustivity of data’s collection. Results: 7,610 patients from 119 general hospitals were included between 1 January and 31 December 2010. The main patient characteristics were: mean age 65.5 years (+/-11.3); 24.3% female; 10.9% non-smokers, 39.9% ex-smokers, 49.2% current smokers; 68.9% performance status 0 and 1; 9.1% of patients had lost >10 kg within the previous 3 months. The main tumour characteristics were: 13.7% small-cell lung cancer; 46.2% adenocarcinoma, 26.8% squamous-cell carcinoma; EGFR mutation, explored in 30.5% of cases, were found in 10.5% of cases; 16.4% stage IA to IIB, 13.4% stage IIIA, 10.2% stage IIIB and 60.0% stage IV. First-line treatments were: curative surgery, 16.6%; chemotherapy, 63.4%; radiotherapy alone, 17.8%; combined radio-chemotherapy, 8.8%; and supportive care, 11.1%. Targeted therapy was used in 6.6% of patients treated by chemotherapy. Conclusions: In 10 years, characteristics of lung cancer patients changed with an significantly increase of women, non-smokers, adenocarcinoma histology and stage IV at diagnosis.

Prevalence of prognostic uncertainty and impact on prognostic discussions in thoracic oncology.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 33-33
Author(s):  
Anand Habib ◽  
Zilu Zhang ◽  
Anna Tanasijevic ◽  
Richard Chen ◽  
Mark M. Awad ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Professional Training ◽  
Stage Iv ◽  
Personal Characteristics ◽  
Advanced Lung Cancer ◽  
Academic Affiliation ◽  
Cancer Management ◽  
Tolerance Of Uncertainty ◽  
Prognostic Uncertainty ◽  
Stage Lung Cancer

33 Background: Recent advances for late-stage lung cancer may have led to a shift from therapeutic ‘nihilism’ to ‘optimism’ (Temel, JCO 2016). It is not known whether this shift has increased prognostic uncertainty nor whether oncologists’ tolerance of uncertainty affects their prognostic discussion practices. Methods: In October 2018, we sent a 34-item survey by FedEx to a random sample of thoracic oncologists (n=444) listed in the publicly-available ASCO directory. The survey assessed professional training, perceptions of prognostic uncertainty for advanced lung cancer, prognostic discussion practices, uncertainty tolerance using an adapted Physicians’ Reactions to Uncertainty (PRU) scale (Gerrity , Motivation and Emotion 1995), and presented a clinical vignette. Results: We received 178 completed surveys from thoracic oncologists in 36 states (response rate: 40.4%). Median duration of practice was 29 years, and 56.7% endorsed an academic affiliation. 52.3% agreed that “there is more prognostic uncertainty in the management of lung cancer now than there was 10 years ago,” and 36.4% noted difficulty “staying up-to-date on the most recent science” in lung cancer management. Surprisingly, only 78.4% reported discussing prognosis with the vast majority (>95%) of their patients. In univariable logistic regression analyses, respondents had lower odds of reporting discussing prognosis with >95% of their patients if they scored highly on the PRU ‘anxious due to uncertainty’ subscale (OR=0.39 [0.18,0.83]), the PRU’s ‘reluctant to disclose uncertainty’ subscale (OR=0.43 [0.20,0.93]) or were male (OR=0.28 [0.08,0.97). Those with higher reluctant to disclose uncertainty scores were also less likely to agree that they would discuss life expectancy when first meeting a patient with stage IV NSCLC presented in the vignette (p=0.014). Conclusions: Data from this geographically diverse cohort of lung cancer oncologists suggest there is increasing prognostic uncertainty within thoracic oncology, and that many find it challenging to stay current with practice changes. Moreover, oncologists’ personal characteristics including gender and uncertainty tolerance may affect their propensity to discuss prognosis.

scholarly journals Molecular and Clinical Features of Hospital Admissions in Patients with Thoracic Malignancies on Immune Checkpoint Inhibitors

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2653
Author(s):  
Dan Zhao ◽  
Haiqing Li ◽  
Isa Mambetsariev ◽  
Chen Chen ◽  
Rebecca Pharaon ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Hospital Admissions ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Cox Models ◽  
Lung Cancer Patients ◽  
Thoracic Malignancies

Lung cancer patients undergoing systemic treatment with immune checkpoint inhibitors (ICIs) can lead to severe immune-related adverse events (irAEs) that may warrant immediate hospitalization. Patients with thoracic malignancies hospitalized at City of Hope while undergoing treatment with ICIs were identified. Pathology and available next-generation sequencing (NGS) data, including the programmed death-ligand 1 (PD-L1) status and clinical information, including hospitalizations, invasive procedures, and the occurrence of irAEs, were collected. Unpaired T-tests, Chi-square/Fisher’s exact test, and logistic regression were used to analyze our cohort. The overall survival (OS) was calculated and compared using univariate and multivariate COX models. Ninety patients with stage IV lung cancer were admitted after ICI treatment. Of those patients, 28 (31.1%) had documented irAEs. Genomic analyses showed an enrichment of LRP1B mutations (n = 5/6 vs. n = 7/26, 83.3% vs. 26.9%; odds ratio (OR) (95% confidence interval (CI): 13.5 (1.7–166.1); p < 0.05) and MLL3 mutations (n = 4/6, 66.7% vs. n = 5/26, 19.2%; OR (95% CI): 8.4 (1.3–49.3), p < 0.05) in patients with irAE occurrences. Patients with somatic genomic alterations (GAs) in MET (median OS of 2.7 vs. 7.2 months; HR (95% CI): 3.1 (0.57–17.1); p < 0.05) or FANCA (median OS of 3.0 vs. 12.4 months; HR (95% CI): 3.1 (0.70–13.8); p < 0.05) demonstrated a significantly shorter OS. Patients with irAEs showed a trend toward improved OS (median OS 16.4 vs. 6.8 months, p = 0.19) compared to hospitalized patients without documented irAEs. Lung cancer patients who required treatment discontinuance or interruption due to irAEs (n = 19) had significantly longer OS (median OS 18.5 vs. 6.2 months; HR (95% CI): 0.47 (0.28–0.79); p < 0.05). Our results showed a significant survival benefit in lung cancer patients hospitalized due to irAEs that necessitated a treatment interruption. Patients with positive somatic GAs in MET and FANCA were associated with significantly worse OS compared to patients with negative GAs.

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