The relative impact of patient and institutional rurality on lung cancer disparities.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20052-e20052
Author(s):  
Meredith Ray ◽  
Nicholas Ryan Faris ◽  
Anna Derrick ◽  
Matthew Smeltzer ◽  
Raymond U. Osarogiagbon
Keyword(s):  
Lung Cancer ◽  
Clinical Stage ◽  
Care Patient ◽  
Patient Level ◽  
Appropriate Care ◽  
Chi Squared ◽  
Cox Proportional Hazard Regression ◽  
Nsclc Patients ◽  
Cancer Network ◽  
To Receive

e20052 Background: We quantified variation in stage specific, guideline concordant treatment and examined the interaction with rurality and overall survival (OS). Methods: We used tumor registry data for non-small cell lung cancer (NSCLC) patients at 5 institutions in the Mississippi Delta from 2011-2017, including patient demographics, clinical stage, treatment, and OS. We defined rurality by Rural-Urban Commuting Area codes, hospital and patient zip codes; based stage-stratified treatment on National Comprehensive Cancer Network guidelines; used Chi-squared and ANOVA F-tests to assess differences across institutions and logistic regression to assess associations between appropriate care, patient- and institution-level rurality. We used Log-rank tests to examine differences in OS and Cox proportional hazard regression to calculate hazard ratios (HR). Results: 6,259 patients were identified across 2 rural (n = 1255, 20%) and 3 metropolitan (metro) institutions (n = 5004, 80%). There were significant demographic and clinical differences between institutions: proportion of African-Americans (range: 6-37%, p < 0.001), uninsured (3-18%, p < 0.001), patient rurality (17-99%, p < 0.001), ‘no treatment’ rates (17-31%, p < 0.001). Metro patients or those treated at metro institutions were more likely to receive guideline-concordant treatment (odds ratio: 1.34, 95% CI [1.20 - 1.49]; 1.45 [1.28 - 1.65], respectively) than their rural counterparts and had improved OS (HR: 0.89; 95% CI [0.84 - 0.95]; 0.68 [0.63 - 0.72], respectively). They were also less likely to receive ‘no treatment’ (0.62 [0.55 - 0.71], p < 0.001; 0.51 [0.49 - 0.66], p < 0.001, respectively). Among patients with proper care, there were no patient-level rurality based OS differences (p = 0.2203) but those treated at metro institutions had better OS (p < 0.001). When stage-stratified, only advanced-stage patients treated at metro institutions had better survival (p < 0.001), no other differences in OS were detected for early or late-stage patients. Conclusions: Institution-level rurality had greater influence than patient-level rurality on receipt of guideline concordant care and OS. Appropriate care eliminated patient-level rurality OS disparities.

scholarly journals Liquid Biopsy Analysis in Clinical Practice: Focus on Lung Cancer

2021 ◽  
Vol 2 (3) ◽  
pp. 241-254
Author(s):  
Pasquale Pisapia ◽  
Francesco Pepe ◽  
Antonino Iaccarino ◽  
Roberta Sgariglia ◽  
Mariantonia Nacchio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Liquid Biopsy ◽  
Treatment Options ◽  
Molecular Testing ◽  
Specific Information ◽  
Sample Collection ◽  
Timely Manner ◽  
Oncology Practice ◽  
Nsclc Patients ◽  
To Receive

Lung cancer is the leading cause of cancer death worldwide. Despite the emergence of highly effective targeted therapies, up to 30% of advanced stage non-small cell lung cancer (NSCLC) patients do not undergo tissue molecular testing because of scarce tissue availability. Liquid biopsy, on the other hand, offers these patients a valuable opportunity to receive the best treatment options in a timely manner. Indeed, besides being much faster and less invasive than conventional tissue-based analysis, it can also yield specific information about the genetic make-up and evolution of patients’ tumors. However, several issues, including lack of standardized protocols for sample collection, processing, and interpretation, still need to be addressed before liquid biopsy can be fully incorporated into routine oncology practice. Here, we reviewed the most important challenges hindering the implementation of liquid biopsy in oncology practice, as well as the great advantages of this approach for the treatment of NSCLC patients.

scholarly journals Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stage IA non-small cell lung cancer

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Sunyin Rao ◽  
Lianhua Ye ◽  
Li Min ◽  
Guangqiang Zhao ◽  
Ya Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Clinical Stage Ia ◽  
Stage Ia ◽  
Nsclc Patients

Abstract Objective Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). Methods A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. Results Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05–2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95–2.43; P = 0.08). Conclusions Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.

Treatment patterns of very elderly patients with non-small cell lung cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18110-18110
Author(s):  
G. R. Oxnard ◽  
P. Fidias ◽  
L. V. Sequist
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Patterns ◽  
Small Cell ◽  
Small Cell Lung ◽  
Very Elderly ◽  
Nsclc Patients ◽  
To Receive

18110 Background: Among patients with non-small cell lung cancer (NSCLC), patients aged 80 or older, termed the ‘very elderly‘, have inferior survival. Treatment patterns within this patient population are poorly described. Methods: A retrospective chart review was performed of 111 outpatients with NSCLC presenting at age 80 or older to an academic referral center over 5.3 years. Based upon available literature regarding elderly patients with NSCLC, a guideline recommended therapy (GRT) was determined for each tumor stage. Each patient’s treatment regimen was evaluated for consistency with the GRT. Particular attention was paid to how patient characteristics and attitudes influenced therapy decisions. Results: Patients characteristics included: median age 82.6 (range 80–92); 50% male; 55% adenocarcinoma, 19% squamous cell; 30% stage I-II, 28% stage III, 39% stage IV; and 59% performance status (PS) 0–1, 25% PS = 2 (PS not available for 15%). 89% of patients received some form of anti-neoplastic therapy and 11% were treated with best supportive care alone. Of 34 patients with localized disease, 53% underwent tumor resection and 38% received definitive radiation. Of 74 patients with stage III or IV disease, 34% received cytotoxic chemotherapy. Radiotherapy (47%) and oral targeted therapy (35%) were the most common treatment modalities overall. 32% of patients received the stage-specific GRT. Multivariable analysis demonstrated that independent predictors for failing to receive GRT included PS = 2 (odds ratio [OR] 17.1, 95% confidence interval [CI] 2.2–135) and age =85 (OR 4.8, 95% CI 1.0–23.4) Of the patients who failed to receive GRT, 19% electively refused GRT that was offered (13% specifically refused chemotherapy), and 76% were not offered GRT (44% due to PS or comorbidities, 32% due to age or unstated reasons). Conclusions: The vast majority of NSCLC patients age 80 or above receive some form of anti-neoplastic therapy, but only one-third of this population receives the stage-specific GRT. The strongest predictor of treatment with GRT is PS 0–1; those with poor PS are 17-fold less likely to receive GRT. A small but clinically significant portion of patients elect against the offered GRT; more data is needed about the attitudes of these patients toward therapy. No significant financial relationships to disclose.

scholarly journals Expression and Diagnostic Efficacy of miR-126-5p and miR-34c-3p in Serum Extracellular Vesicles of Non-Small Cell Lung Cancer Patients

2021 ◽  
Author(s):  
Jie Zhao ◽  
Wenlu Hang ◽  
Qian Wang ◽  
Yonghong Xu
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Small Cell Lung Cancer ◽  
Poor Prognosis ◽  
Clinical Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Node Metastasis ◽  
Nsclc Patients

Abstract Background: Non-small cell lung cancer (NSCLC) is a disease with quite grave prognosis. This study explored the diagnostic efficiency of miR-126-5p and miR-34c-3p in serum extracellular vesicles (EVs) in NSCLC patients.Methods: Serum EVs were extracted from NSCLC patients and healthy people and verified. The expression of miR-126-5p and miR-34c-3p in serum EVs were tested. Correlation of miR-126-5p and miR-34c-3p expression and diagnosis, prognosis and pathological characteristics (age, gender, tumor size, clinical stage, and lymph node metastasis) of NSCLC patients was analyzed. The downstream targets of miR-126-5p and miR-34c-3p were predicted and their roles in diagnosis and prognosis of NSCLC patients were evaluated.Results: miR-126-5p and miR-34c-3p were poorly expressed in serum EVs of NSCLC patients and their low expressions were associated with clinical stage, lymph node metastasis and prognosis of NSCLC patients and could be used as biomarkers for diagnosis. As the common target genes of miR-126-5p and miR-34c-3p, LYPLA1 and CDK6 were highly expressed in serum EVs and were associated with poor prognosis in NSCLC patients.Conclusion: Lowly expressed miR-126-5p and miR-34c-3p in serum EVs of NSCLC patients can serve as biomarkers for diagnosis and are linked with prognosis. As common targets of miR-126-5p and miR-34c-3p, LYPLA1 and CDK6 are also associated with poor prognosis in NSCLC patients.

scholarly journals Identification of Circulating miR-762 as a Novel Diagnostic and Prognostic Biomarker for Non-Small Cell Lung Cancer

2020 ◽  
Vol 19 ◽  
pp. 153303382096422
Author(s):  
Lei Chen ◽  
Yunxia Li ◽  
Jingshu Lu
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Prognostic Biomarker ◽  
Clinical Stage ◽  
Small Cell ◽  
Proliferative Capacity ◽  
Healthy Individuals ◽  
Small Cell Lung ◽  
Nsclc Patients

Background: MicroRNAs (miRNAs) have been demonstrated to play critical roles in tumorigenesis of non-small cell lung cancer (NSCLC), and circulating miRNAs are a valuable source of biomarkers for the clinical management of NSCLC. The aim of this study was to determine the value of serum miR-762 as a diagnostic and prognostic biomarker for NSCLC. Methods: We examined circulating miR-762 expression in 148 NSCLC patients and 60 healthy individuals using the quantitative real-time polymerase chain reaction (qRT-PCR). The effect of miR-762 downregulation on the proliferative capacity of NSCLC cells were also explored. Results: The serum miR-762 levels were significantly upregulated in NSCLC patients compared to the healthy individuals. Receiver operating characteristics (ROC) curve analysis revealed that circulating miR-762, carcinoembryonic antigen (CEA), CYFRA21-1 and a combination of these 3 biomarkers yield the areas under the curve (AUC) of 0.874, 0.826, 0.41 and 0.969, respectively. Interestingly, circulating miR-762 identified the NSCLC patients at the clinical stage I from healthy controls with an AUC value of 0.920. In addition, serum miR-762 expression was significantly correlated with clinical stage, lymph node metastasis, histological grade and gefitinib-resistance. The survival analysis showed that NSCLC patients in the high serum miR-762 group suffered worse overall survival and relapse-free survival than those in the low serum miR-762 group. The multivariate Cox proportional hazards regression analysis revealed high circulating miR-762 was an independent unfavorable prognostic factor. Downregulation of miR-762 significantly suppressed the proliferative capacity of NSCLC cells in vitro, and bioinformatic analysis of the potential downstream targets of miR-762 identified many important cancer-associated pathways. Conclusions: In conclusion, serum miR-762 might serve as a promising diagnostic and prognostic biomarker for the NSCLC.

Treatment and outcome of patients with brain metastases from non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19058-e19058
Author(s):  
A. Ali ◽  
J. R. Goffin ◽  
A. Arnold ◽  
P. M. Ellis
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Brain Metastases ◽  
Outcome Data ◽  
Solitary Brain Metastasis ◽  
Lung Cancer Patients ◽  
Outcomes Of Care ◽  
Nsclc Patients ◽  
To Receive ◽  
Subsequent Time Point

e19058 Background: The prognosis of patients with brain metastases from NSCLC is generally poor. However, some reports suggest that the outlook of patients with brain metastases at the time of diagnosis may be similar to that of patients with advanced NSCLC without brain metastases. We undertook a retrospective review of NSCLC patients with brain metastases to examine the outcomes of care for patients with brain metastases from NSCLC. Methods: All new lung cancer patients seen in our institution between July 2005 and June 2007 were assessed for the development of brain metastases. Baseline characteristics, treatment and outcome data were extracted from the chart. The primary outcome of interest was a comparison of survival of patients with brain metastases at diagnosis compared with patients who developed brain metastases later. Results: 91 of 878 (10.4%) new patients seen over the 2 years developed brain metastases. There were 43 men and 48 women. The median age was 64 yrs (sd 10.6yrs). 45 patients had brain metastases at presentation while 46 developed brain metastases later. 34 (37%) had a solitary brain metastasis. 18 (20%) underwent surgical resection. The median overall survival for all patients was 7.8m. Patients with brain metastases at diagnosis had a significantly shorter overall survival than patients who developed brain metastases later (9.8m v 4.3m, p=0.001). Survival following diagnosis of brain metastases was similar for both groups (3.7m v 4.8m, p=0.53). Patients presenting with brain metastases were less likely to be referred to a medical oncologist (51% v 74%, p=0.02) and less likely to receive chemotherapy (18% v 41%, p=0.01). Conclusions: These data suggest that NSCLC patients with brain metastases at diagnosis have a significantly worse outcome than patients who develop brain metastases at a subsequent time point in their illness. Few patients received systemic therapy following diagnosis of brain metastases and further research is needed to determine the utility of chemotherapy in this patient group. No significant financial relationships to disclose.

Oncologist decision drivers in stage III non-small cell lung cancer: Outcomes of a web-based survey.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 35-35
Author(s):  
Adam Yagui-Beltran ◽  
Kellie Ryan ◽  
Marnie L. Boron ◽  
Ion Cotarla ◽  
Daryl S. Spinner ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Decision ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Web Based ◽  
Unresectable Stage ◽  
Stage Iii Nsclc ◽  
Nsclc Patients ◽  
To Receive

35 Background: Clinical guidelines seek to optimize patient care. We investigated how oncologists manage stage III non-small cell lung cancer (NSCLC) patients from diagnosis through treatment decision-making and drivers impacting guideline adherence. Methods: A sample of US medical oncologists (n=150) participated in a 38-question, 25-min web-based quantitative survey in January 2019. Participation required at least 3 yrs in practice and 3 stage III NSCLC patients treated in the prior 6-mo period. Results: Surveyed oncologists (82% community; 18% academic), on average, had 15 yrs of clinical experience and treated 20 stage III NSCLC patients in the prior 6 mos. Time from first treatment decision to initiation averaged >2–4 wks in 31% and >4 wks in 20% of patients, respectively. Oncologists recommend definitive concurrent chemoradiation therapy (cCRT) in 48% of unresectable stage III NSCLC patients. Reasons for not recommending cCRT include patient unlikely to tolerate cCRT (64% of oncologists), presence of a targetable mutation (41%), patient inability to travel consistently to receive treatment/inconvenient dosing (41%), and patient cost/affordability (34%). Eighteen percent of unresectable stage III NSCLC patients decline recommended cCRT. Fifty-five percent of patients who receive cCRT go on to receive consolidation immunotherapy (IO). Insurance challenges led to oncologists not recommending consolidation IO in 19% of patients. In the 85% of oncologists who conduct EGFR or PD-L1 testing, positive EGFR or negative PD-L1 tests are reasons for not recommending consolidation IO in 27% of patients (12% and 15%, respectively). Over half (55%) of unresectable stage III NSCLC patients who receive definitive cCRT also receive consolidation chemotherapy, which is no longer recommended in guidelines. Patients receiving consolidation CT were less likely to receive consolidation IO than the overall cohort of patients receiving cCRT (42% vs. 55%). Conclusions: Oncologists reported important variances in guidelines and standards of care related to the stage III NSCLC patient treatment journey. While some deviations from both are expected, there may be areas of focus for quality improvement initiatives.

Association of age 40 and older with adverse outcome in metastatic testicular cancer (TC).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 386-386
Author(s):  
Rowan Miller ◽  
Sarah C Markt ◽  
Elizabeth O'Donnell ◽  
Brandon David Bernard ◽  
Laurence Albiges ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Tumour Size ◽  
Clinical Stage ◽  
Patient Characteristics ◽  
Primary Treatment ◽  
Risk Of Death ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
To Receive ◽  
Risk Of Relapse

386 Background: We sought to determine factors associated with poorer outcome in older patients (≥ 40) with TC in a large institutional dataset. Methods: A retrospective review of a 1095 patient, IRB approved database, of men treated for TC between 1997 and 2012 at the Dana-Farber Cancer Institute was performed. Information regarding histology, stage, treatment and patient characteristics was obtained from electronic medical records. Using logistic regression analysis and Cox proportional hazard regression we investigated the association between age and outcome for (a) men with clinical stage 1 (CS1) TC and (b) men with metastatic TC, either at diagnosis or following CS1 relapse. Results: 26% of the TC patients were ≥ 40 at diagnosis. Amongst the 616 men with CS1 disease 150 (24%) were age ≥ 40, there was an association with increased likelihood of seminoma (OR 2.46, 95%CI 1.68-3.60) and larger tumour size (> 4cm, OR 1.81, 95%CI 1.23-2.66). Age ≥ 40 was not associated with an increased risk of relapse (HR 0.931, 95%CI 0.575-1.505, p=0.77). 605 men (159, 26% ≥ 40) with metastatic disease were identified. Men ≥ 40 were more likely to have seminoma (OR 3.07 95%CI 2.07-4.54). Distribution of IGCCC prognostic stage was similar in men < 40 and ≥ 40. After adjusting for stage and histology, men ≥ 40 were more likely to receive chemotherapy other than BEP as their primary treatment (OR 1.87 95%CI 1.17-3.00, p=0.009) and men ≥ 40 were also more likely to receive non-optimal chemotherapy than men < 40 (OR 2.91 95%CI 1.12-7.60, p=0.03). When adjusted for confounding variables, age ≥ 40 was associated with a non-significant increased risk of relapse (HR 1.467 95%CI 0.94-2.29, p=0.09) post primary treatment and a significant increased risk of death from TC (HR 2.41 95%CI 1.41-4.11, p=0.0013), which was greater for those with non-seminoma (HR 2.54 95%CI 1.45-4.44, p=0.0011) than seminoma (HR 1.53, 95%CI 0.33-7.2, p=0.56). Conclusions: Men ≥ 40 years diagnosed with metastatic TC were less likely to be cured with therapy for metastatic disease compared to men < 40.

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