Factors associated with overall survival in patients with non-squamous NSCLC in New Zealand: A comparative analysis by EGFR gene mutation status

2020 ◽  
Author(s):  
Phyu Sin Aye ◽  
Mark James McKeage ◽  
Sandar Tin Tin ◽  
Prashannata Khwaounjoo ◽  
J Mark Elwood
Keyword(s):  
Overall Survival ◽  
New Zealand ◽  
Cox Regression ◽  
Smoking Status ◽  
Performance Status ◽  
Specific Gene ◽  
Mutation Status ◽  
Lower Survival ◽  
Nsclc Patients ◽  
Positive Groups

Abstract Introduction: Non-small cell lung cancer (NSCLC) is increasingly regarded as a heterogeneous group of diseases defined by specific gene mutations. Previous studies reported inconsistent results regarding the influence of epidermal growth factor receptor (EGFR) mutations on overall survival. This study assesses the effect of EGFR mutation on overall survival, and how the effects of other survival predictors are modified by EGFR mutation status, in non-squamous NSCLC patients.Methods: The study was based on a population-based cohort of 1534 non-squamous NSCLC patients who were registered in northern New Zealand between 1 February 2010 and 31 July 2017. Kaplan-Meier analyses and log-rank tests were performed to assess the overall survival among different patient groups. Cox regression survival analyses were used to explore the associations between clinico-pathological factors and overall survival in terms of EGFR mutation status. The factors included were age at diagnosis, sex, ethnicity, smoking status, performance status, metastasis status and site of tumour. Results: In this cohort, 20.2% had an EGFR mutation. The median overall survival was 0.79 years and 2.81 years in EGFR mutation-negative and mutation-positive groups respectively (log-rank p<0.0001). Metastasis status showed large and significant effects on overall survival in both EGFR mutation-negative and mutation-positive groups (hazard ratio, HR=3.6 and 3.3, respectively). In subgroup analyses by mutation status and metastasis status, overall survival decreased with an increase in age and decrease in performance status, and was lower in current smokers in all subgroups. In specific groups, females had lower survival only if mutation-positive; Māori had lower survival compared to NZ Europeans only if the disease was metastatic; and tumour site had significant effects on overall survival only in patients without metastasis. Conclusion: EGFR mutation status and metastasis are the main predictors for overall survival in non-squamous NSCLC patients in northern New Zealand. The effects of age, smoking status and performance status are similar in all subgroups, but the effects of sex, ethnicity and site of tumour vary depending on EGFR mutation and metastasis status.

scholarly journals 312 Female sex independently predicts adjuvant immunotherapeutic benefit from CTLA4 immune checkpoint inhibition

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A339-A339
Author(s):  
Ahmad Tarhini ◽  
Ni Kang ◽  
Sandra Lee ◽  
F Stephen Hodi ◽  
Gary Cohen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Efficacy ◽  
Significant Interaction ◽  
Cox Regression ◽  
Performance Status ◽  
Phase Iii ◽  
High Dose ◽  
List Type ◽  
Female Sex ◽  
Interaction Term

BackgroundSex differences in tumor immunity and response to immunotherapy were shown in murine models and descriptive analyses from recent clinical trials. Female sex hormones have been implicated in melanoma development and response to systemic therapy. We hypothesized a gender difference in response to adjuvant immunotherapy with ipilimumab (3 or 10 mg/kg; ipi3 or ipi10) versus high dose IFNα (HDI) as tested in the E1609 trial.MethodsE1609 demonstrated significant overall survival (OS) benefit with ipi3 versus HDI.1 We investigated treatment efficacy between ipi and HDI in the subgroups by sex (female, male), age (< 55 or ≥55), stage at study entry (IIIB, IIIC, M1a/1b), ECOG performance status (PS 0, 1), ulceration (yes, no), primary tumor (known, unknown), number of lymph nodes involved (0, 1, 2–3, 4+). Forest plots were created to compare OS and RFS with ipi3 vs. HDI and ipi10 vs. HDI using the concurrently randomized ITT populations. For the estimated HRs, 95% confidence intervals were created for all subgroups.ResultsThe subgroups of female, stage IIIC, PS=1, ulcerated, in-transit without lymph node involvement demonstrated significant improvement in overall survival (OS) and/or relapse free survival (RFS) with ipi3 versus HDI as summarized in table 1. Female sex was significant for both OS and RFS and was further explored. In investigating RFS with ipi3 versus HDI, a multivariate Cox regression model including sex, treatment and interaction term of sex*treatment, indicated a significant interaction between sex and treatment (P = 0.026). Including sex, PS (0 vs. 1), age (<55 vs. 55+), ulceration (yes vs. no), stage (IIIB, IIIC, M1a, M1b), treatment and interaction term of sex*treatment, indicated a significant interaction between sex and treatment (P = 0.024). While similar trends were seen, no significant interactions between sex and treatment effect were found in the OS multivariate analysis or in the comparison of ipi10 versus HDI. When exploring age, in the univariate analyses in the ipi3 versus HDI comparison older women appeared to drive most of the difference (age ≥55: OS, P=0.02 and RFS, P=0.08; differences non-significant for women <55). Table 1.Abstract 312 Table 1Treatment efficacy between ipi3 and HDI by subgroupConclusionsFemale sex was independently associated with RFS adjuvant immunotherapeutic benefit from ipi3, supporting a potentially important role for female related factors in the immune response against melanoma, and these warrant further investigation.Trial RegistrationNCT01274338Ethics ApprovalThe study protocol was approved by the institutional review board (IRB) of each participating institution and conducted in accordance with Good Clinical Practice guidelines as defined by the International Conference on Harmonisation. This study was monitored by the ECOG-ACRIN DataSafety Monitoring Committee and the NCI.ConsentAll patients provided IRB-approved written informed consent.ReferenceTarhini AA, Lee SJ, Hodi FS, Rao UNM, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Eroglu Z, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Streicher H, Sondak VK, Kirkwood JM. Phase III Study of Adjuvant Ipilimumab (3 or 10 mg/kg) Versus High-Dose Interferon Alfa-2b for Resected High-Risk Melanoma: North American Intergroup E1609. J Clin Oncol. 2020 Feb 20;38(6):567–575. PMID: 31880964.

Impact of ECOG performance status on recurrent/metastatic head and neck squamous cell carcinomas treated with anti-PD1 inhibitors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18004-e18004
Author(s):  
Cameron Chalker ◽  
Vicky Wu ◽  
Jenna M. Voutsinas ◽  
Victoria Hwang ◽  
Christina S Baik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcomes ◽  
Squamous Cell ◽  
Smoking Status ◽  
Demographic Data ◽  
Performance Status ◽  
Univariate Analysis ◽  
Single Agent ◽  
Ecog Performance Status ◽  
Hpv Status

e18004 Background: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard of care for patients with recurrent/metastatic head & neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥ 2; the benefit of ICI in this population is therefore unknown. Methods: We retrospectively reviewed RMHNSCC patients who received at least 1 dose of ICI at our institution. Demographic data and clinical outcomes were obtained; the latter included objective response to ICI (ORR), physician-documented CTCAE grade 2+ toxicity (irAE), and any unplanned hospitalization within 100-days of last ICI dose (UH). Associations between demographic data and clinical outcomes were explored using both uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, irAE, and UH were evaluated with logistic regression. This project was approved by our institutional IRB. Results: We identified 152 RMHNSCC patients who were treated with ICI between 1/2013 and 1/2019. ECOG PS was 0 in 42 (27%), 1 in 75 (50%), 2 in 27 (18%), 3 in 2 (1%), and unknown in 6 (4%) patients. The median age was 61 (range: 25 - 90). 124 (82%) were male, 124 (82%) were white, and 69 (45%) were never-smokers. The most common primary sites were the oropharynx (n = 59, 40%), oral cavity (n = 39, 26%), nasopharynx (n = 11, 7%), and larynx (n = 10, 6%). 54 (36%) were p16+ oropharynx cancers. CPS score was available in 10 (6.6%). Single agent ICI was received by 118 (77%) patients. 66 (44%) had a documented irAE and 54 (36%) had an UH. A multivariate model for OS containing PS, smoking status and HPV status showed a strong association between inferior OS and ECOG 2/3 compared to 0/1 (p < 0.001; HR = 3.30, CI = 2.01-5.41), as well as former (vs. never) smoking status (p < 0.001; HR = 2.17, CI = 1.41-3.35). Current smoking (p = 0.25) did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05—5.71). There was no significant association between irAE and any patient characteristic. Conclusions: We observed inferior overall survival among ICI-treated RMHNSCC patients with ECOG 2/3 in our single-institution, retrospective series. Our findings help frame discussion of therapeutic options in this poor-risk population. Further study must be done to determine which interventions are of greatest benefit for RMHNSCC patients with declining performance status.

More Sun Light Exposure May Be Associated with Improved Overall Survival in Diffuse Large B-Cell Lymphoma. A Population Based Swedish Lymphoma Registry Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4847-4847
Author(s):  
Mats Jerkeman ◽  
Elisabeth Székely ◽  
Oskar Hagberg ◽  
Ola Linden
Keyword(s):  
Vitamin D ◽  
Overall Survival ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Light Exposure ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Ultraviolet B ◽  
Vitamin D Levels ◽  
Sun Light

Abstract Abstract 4847 Background Low levels of circulating 25-hydroxyvitamin D [25(OH)D] has been associated with inferior EFS and OS in DLBCL[1]. Ultraviolet B radiation from the sun contributes strongly to the vitamin D status in humans. In Scandinavia, the difference in sun light exposure is highly dependent on season. Consequently, vitamin D levels in Norway have been found to be 15–50 % lower in winter compared to summer[2]. In this study we tested the hypothesis that diagnosis of DLBCL during the lighter period of the year may be related to superior overall survival in DLBCL. Patients and materials The study population was collected from the Swedish Lymphoma Registry 2000–2010. A Cox regression model was analyzed for overall survival. Light exposure was defined as a continuous variable - cos((month of diagnosis -6)/12 × 2π) – varying between -1 in December and +1 in June. In addition, age, stage, year of diagnosis, performance status, number of extranodal sites, and LDH were included as cofactors. Results During this period, 5268 adult patients with DLBCL were identified. In multivariate analysis, including all factors above, overall survival was significantly superior for patients diagnosed during the lighter part of the year, p = 0.032. The hazard ratio for death due to all causes for patients diagnosed in June compared to December was 0.90. Monthly Discussion On a population level, seasonal differences in sun light exposure may contribute to differences in overall survival in DLBCL. However, to prove if normalizing vitamin D levels in this group of patients would improve survival; this will require testing in randomized trials. Disclosures: No relevant conflicts of interest to declare.

Study of genotypic variations and protein expression of the xCT subunit of cystine/glutamate transporter in pancreatic cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 210-210
Author(s):  
T. J. Huang ◽  
D. Li ◽  
Y. Li ◽  
S. P. Kar ◽  
S. Krishnan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Protein Expression ◽  
Cox Regression ◽  
Performance Status ◽  
Glutamate Transporter ◽  
Supporting Evidence ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk

210 Background: The plasma membrane xCT cystine-specific subunit of the cystine/glutamate transporter contributes to chemotherapy resistance in pancreatic cancer by regulating intracellular glutathione levels and protecting cancer cells against oxidative stress. We previously noted that the rs7674870 single nucleotide polymorphism (SNP) of xCT correlated with overall survival in pancreatic cancer and may be predictive of platinum resistance. There are no data regarding xCT protein expression in pancreatic cancer or the functional significance of this SNP. Methods: Paraffin-embedded core and surgical biopsy tumor specimens from 49 patients with metastatic pancreatic adenocarcinoma were analyzed by immunohistochemistry (IHC) using an xCT specific antibody (Novus Biologicals). xCT protein IHC expression scores (product of intensity and percentage of staining cells) were analyzed in relation to overall survival and genotype of the patients using the one factor ANOVA test, Kaplan-Meier plot, log-rank test, and Cox regression analysis. Overall survival was measured from the date of diagnosis to the date of death or last follow-up. Results: Positive xCT expression was detected in 38 (78%) of the 49 samples, and 9 (18%) patients had high levels of expression. High xCT expression was associated with lower overall survival as compared with low expression (5.1 months versus 8.8 months; p = 0.119). In a multivariate Cox regression model with adjustment for prognostic parameters of age, sex, performance status and CA19-9 level, high xCT expression was associated with a 2.1-fold increased risk of death (p = 0.096). Performance status also correlated with overall survival (p = 0.027). Preliminary analysis on the genotype-phenotype association (n = 12) indicated that xCT expression was higher with the TT genotype than the TC/CC genotype (p = 0.115), which is consistent with the previous observation that the TT genotype was associated with reduced survival. Conclusions: These data provide supporting evidence for a possible role of cystine/glutamate transporter xCT subunit in pancreatic cancer progression and survival. Further pharmacogenomic and clinicopathologic studies are ongoing. No significant financial relationships to disclose.

Urothelial cancer: Impact of gender on stage at diagnosis and survival.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 316-316
Author(s):  
Jeanne Michelle du Manoir ◽  
Suzanne Richter ◽  
Srikala S. Sridhar
Keyword(s):  
Gender Differences ◽  
Overall Survival ◽  
Organ Dysfunction ◽  
Urothelial Cancer ◽  
Smoking Status ◽  
Performance Status ◽  
Stage Iv ◽  
Gender Disparity ◽  
Stage At Diagnosis ◽  
Stage Iv Disease

316 Background: Gender differences for disease course and survival in various cancers exist. Gender disparity for both stage at diagnosis and overall survival (OS) has been observed in urothelial cancer (UC). We report a single institution analysis of UC patients treated with chemotherapy to further investigate gender differences in outcomes. Methods: We identified 198 bladder cancer pts treated with chemotherapy since 2002. Chemotherapy was either given as adjuvant or palliative and the most common regimens used were gemcitabine and cisplatin, gemcitabine and carboplatin or gemcitabine alone. Age and stage at diagnosis, sex, smoking status, radiation exposures, bloodwork as a measure of organ dysfunction and overall survival info was collected. Outcomes were compared using Chi Square Statistic. Results: Age at diagnosis, smoking status and prior pelvic radiation were not significantly different (females 66.1 yrs vs males 63.6 yrs; 54% smokers in both groups; 8.3% females vs 7.6% males exposed to radiation). Significantly more females were diagnosed with advanced disease than men (70.8% vs 58.7%, p=0.049) vs earlier stages (stage 0-I) (12.2% vs 35.9%, p=0.03). For patients deceased, OS was not significantly different between genders when analysed for all stages combined (deceased 41.5 vs 39.9 mos), or for those diagnosed only at Stage IV (deceased 12.4 vs 8.6 mos). Of patients still alive at time of review, a survival advantage was apparent for men at all stages (54.8 vs 38.7 months), as well as with stage IV disease (35.9 vs 19.7 months). Gemcitabine-cisplatin was given more often to men with stage IV disease than females (93% vs 63%, p<0.02) despite no difference in organ dysfunction, or ECOG performance status in females. Conclusions: We observed that while both genders are similar with respect to age at UC diagnosis, risk factors exposures (smoking, radiation) and pathological variants, females were diagnosed at later stages, and receive standard first line therapy less often. Our data suggest that this impacts negatively on OS in females diagnosed in earlier disease stages. Further research is needed to identify if we can improve outcome by promoting earlier diagnosis and more aggressive management in earlier disease in females.

Patterns of referral to palliative care in clinical practice in patients with stage IV non-small cell lung cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 39-39
Author(s):  
Safiya Karim ◽  
Shahid Ahmed
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Cox Regression ◽  
Smoking Status ◽  
Performance Status ◽  
Stage Iv ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Logistic Regression Models ◽  
Symptomatic Disease

39 Background: Recent evidence has shown that patients with stage IV NSCLC benefit from early referral to palliative care (PC). In August 2010, a landmark randomized control trial revealed that patients with advanced NSCLC, who received early PC, had better quality of life, mood and survival (NEJM 2010; 363:733-42). Our study aimed to determine pattern of PC referral in clinical practice, in patients with stage IV NSCLC before and after the publication of the trial, and to assess factors correlated with PC referral. Methods: The study population was comprised of a cohort of patients with stage IV NSCLC, diagnosed between 2009 and 2011, and referred to the Saskatoon Cancer Center. Logistic regression models were used to assess factors correlated with PC referral. Kaplan Meier method was used to estimate survival. Cox regression analyses were used to determine factors correlated with survival. Results: 215 patients with median age of 68 yrs (range: 40-92) and M:F of 108:107 were identified. 101 (47%) patients had comorbid illness, 100 (47%) had ECOG performance status <2, 136 (63%) were married/common law and 161 (75%) had symptomatic disease. 126/251 (58%) were referred to PC. 70/118 (59%) diagnosed before Sep 2010 were referred to PC compared with 56/97 (58%) diagnosed after Sep 2010 (p=NS). The median time to PC referral from date of diagnosis was 51 days (inter-quartile range: 19-155). 33% patients were referred within 4 wks of diagnosis. Symptomatic disease (odd ratio [OR]=3.7, 95% CI =1.8-7.5), bone metastasis (OR = 3.0, 95% CI = 1.6-5.6), and brain metastasis (OR=2.2, 95% CI =1.1-4.5) were correlated with referral to PC. Median survival of whole cohort was 4 months (95% CI: 3.1-4.8). 2nd or 3rd line therapy (Hazard ratio [HR]= 0.54, 95% CI:0.34-0.87), non-smoking status (HR= 0.58, 95% CI:0.38-0.87), chemotherapy (HR 0.64, 95% CI:0.46-0.89), and lack of symptoms (HR=0.68, 95%CI:0.48-0.96) were correlated with better survival. Conclusions: Our study shows that publication of the landmark trial did not influence the pattern of referral to PC at our center. Symptomatic patients and those with metastasis to brain or bone were more often referred to PC. No survival benefit was seen in patients who were referred to PC.

Charlson Score as prognostic factor in patients with castration-resistant prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 242-242 ◽  
Author(s):  
Gustavo Jankilevich ◽  
Luciana Gennari ◽  
Matias Salazar ◽  
Claudio Graziano ◽  
Eduardo Saravia ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Gleason Score ◽  
Cox Regression ◽  
Independent Predictor ◽  
Performance Status ◽  
Univariate Analysis ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistance

242 Background: Tumor stage, Gleason score, PSA, Performance Status have been identified as important predictors of survival in prostate cancer. The Charlson Comorbidity Index (CCI) is a validated score used to stratify patients according to comorbidities. To evaluate the prognostic role of CCI in patients with CPRC. Methods: A retrospective study based on an analysis of medical records of 212 patients with CRPC treated at Durand Hospital between 2010-2015. The CCI was calculated for each patient and a correlation with overall survival was performed. Statistical analysis included univariate analysis and multivariate analysis (Cox regression). Patients were stratified according CCI ≤ 7.6 or ≥ 7.6. Survival analysis was performed using the Kaplan-Meier curve. Results: We analyzed records of 212 patients with prostate cancer, of which 59 were resistant to castration. Median age 69 years, the PFS with androgen blockade was 32.4 months. Patients with CPRC 54% perform chemotherapy as first-line treatment of castration resistance and 46% performed treatment of hormonal manipulation (Enzalutamide or Abiraterone Acetate). Median overall survival of patients with CCI < 7.6 was 75 months versus 62 months for those with CCI > 7.6 HR: 1.19 (1.03 to 1.36) p: 0.01. In multivariate analysis the ICC was an independent predictor of mortality in these patients HR: 1.23 (1.03 to 1.48) p: 0.02. (Table 1) CCI ≤ 7,6 was predictor to subsequent lines in CPRC setting. Gleason score, PS were independent predictors of survival. Conclusions: Based on our results we can consider the CCI as an independent predictor of survival in CPRC patients. CCI could be an useful tool useful to select patients in clinical trial and community settings. [Table: see text]

Bone metastases as predictors of treatment response and rapidly progressive disease in NSCLC patients on PD-1/PD-L1 immune checkpoint inhibitors (ICI).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20667-e20667
Author(s):  
Sally CM Lau ◽  
Lisa W Le ◽  
Elliot Charles Smith ◽  
Sze Wah Samuel Chan ◽  
Malcolm Ryan ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Bone Metastases ◽  
Cox Regression ◽  
Checkpoint Inhibitors ◽  
Smoking Status ◽  
Clinicopathologic Characteristics ◽  
Metastatic Site ◽  
Overall Response ◽  
Nsclc Patients ◽  
Sites Of Metastases

e20667 Background: The tissue microenvironment associated with specific organ metastases potentially influences the efficacy of checkpoint inhibitors. The presence of liver metastases is a predictor of poor response and survival in melanoma and is correlated with reduced CD8+ T cell infiltration. Our study examined clinicopathologic characteristics, focusing on sites of metastatic disease, that are associated with poor outcomes. Methods: Advanced NSCLC patients treated with ≥1 cycle of ICI were reviewed. Baseline age, sex, histology, stage, smoking status, ethnicity, PD-L1 expression and sites of metastases were recorded. Best overall response (BOR) was determined by clinical imaging response and categorized ordinally as shrinkage, stable, or progression, adapted from RECIST for CR/PR, SD, PD. A rapidly progressive phenotype (RPP) was defined as BOR of progression and ICI use of ≤2 months. The association between sites of metastases and clinical outcomes were investigated using logistic and cox regression models. Results: Among 219 eligible patients, bone was the most common metastatic site (34.7%), followed by brain (21.5%), adrenals (14.2%), and liver (13.7%). Bone metastases (OR 0.45, p = 0.004) were associated with a worse BOR, while only a trend was observed for liver metastases (OR 0.47, p = 0.06). Adrenal metastases were associated with a better BOR (OR 2.08, p = 0.04). But thorax limited disease did not associate with BOR (OR 1.08, p = 0.76). In a multivariate model, bone was the only metastatic site associated with a worse BOR (OR 0.50, p = 0.01). Further, bone metastases were associated with RPP (adjusted OR 1.91, p = 0.04). Both bone (adjusted hazard ratio/aHR 1.61, p = 0.01) and liver metastases (aHR 1.80, p = 0.02) were associated with a shorter time-to-treatment-failure. The presence of liver (aHR 2.63, p < 0.001) but not bone (aHR 1.04, p = 0.86) metastases was a significant predictor of poor OS. Conclusions: We report a novel finding that the presence of bone metastases was associated with a worse clinical overall response on ICI and a rapidly progressive phenotype. Further investigations into the mechanisms of RPP in the presence of bone metastases are needed.

Interest in cessation treatment and survival among smokers in a community-based multidisciplinary thoracic oncology program.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2028-2028
Author(s):  
Meghan Meadows ◽  
Kenneth Daniel Ward ◽  
Nicholas Ryan Faris ◽  
Matthew Smeltzer ◽  
Carrie Fehnel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Social History ◽  
College Graduates ◽  
Cox Regression ◽  
Smoking Status ◽  
Cancer Center ◽  
Willingness To Participate ◽  
Community Based ◽  
Logistic Regression Models

2028 Background: Tobacco cessation is essential to high quality oncology care. Many patients smoke when diagnosed and continue to smoke during treatment, which adversely affects treatment response and survival. Although most patients are motivated to quit, few receive effective cessation therapy. The multidisciplinary clinic (MDC), where patients, their caregivers, and key specialists coordinate care, is an ideal setting to integrate a cessation program. To assess the need for cessation services within a MDC setting, we surveyed incoming patients about their smoking status, interest in quitting, and willingness to participate in a clinic-based cessation program. Methods: The study was conducted in the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center, Memphis TN. We evaluated sociodemographic/clinical characteristics, smoking status, and tobacco dependence of consecutive new patients diagnosed with lung cancer from 2014-2019, who completed a social history questionnaire. Current smokers reported their interest in quitting and their willingness to participate in a cessation program. Chi square tests and logistic regression models were used to compare characteristics of those who would participate vs. those who would not/were unsure. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the association between willingness to participate in a cessation program and overall survival, adjusted for age, sex, race, and total pack-years of smoking. Results: Of 641 patients, the average age was 69 years (range: 32-95), 47% were men, 64% white/34% black, and 17% college graduates; 90% had ever smoked, 34% currently smoked, and 24% quit smoking within the past year. Among current smokers, 60% were very interested in quitting and 37% would participate in a clinic-based cessation program. Willingness to participate was associated with greater interest in quitting (p = 0.0010) and greater overall survival (log rank p = 0.01;HR: 0.48, 95% CI: 0.24-0.95) but was not associated with any sociodemographic, clinical, or smoking-related characteristics. Conclusions: Over half (58%) of patients in a community-based MDC program were current smokers/recent quitters. Willingness to participate in a cessation program was associated with improved survival, suggesting patients with favorable prognoses are especially interested in receiving cessation support. There is considerable need for cessation services and relapse-prevention support within a coordinated, MDC lung cancer care setting.

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