Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
OA04: EPIDEMIOLOGY AND PREVENTION OF LUNG CANCER
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
OA04.03 PRELIMINARY RESULTS OF A LOW COST INTERVENTION
TO IMPROVE TOBACCO CESSATION PRACTICES WITHIN A LARGE
UNIVERSITY HEALTH SYSTEM
Mary Kay Hamby 1 , Allison Nix 2 , Julie Tobi 2 , Kelly Rysso 2 , Douglas Arenberg 3
1 University of Michigan, Ann Arbor/MI/United States of America, 2 University of
Michigan, Ann Arbor/United States of America, 3 Internal Medicine, University of
Michigan, Ann Arbor/MI/United States of America
Background: Tobacco cessation is critical for both population and individual
health, and especially so in the context of a lung cancer screening program.
Our institution initiated formal lung caner screening in 2013. In preparation
for this we audited randomly selected clinic visits to assess adherence to
published tobacco cessation guidelines. Our findings in that study prompted
us to initiate a systematic multi-step program to improve tobacco practices
from assessing tobacco use to presribing pharmacotherapy, and referral to
tobacco cessation counselors. Methods: The project included four separate
but related interventions; 1) Inviting clinic directors to send a clinic staff
member of their choice for formal training in a specialize Tobacco treatment
Specialist (TTS) course. 2) Generating monthly reports showng completeless of
tobacco history (Current/Former/Never), pack-years recording, and (for former
smokers) quit dates, use of pharmacotherapy for current smokers, and referrals
for either tobacco cessation or formal lung cancer screening. 3) Providing
monthly feedback to clinic directors comparing their performance to others
in the project, and 4) Initiation of an electronic Best Practice Alert prompt for
smokers including links to a Lung Cancer Screening Questionaire & decision aid
and referral to Tobacco Counselor. Results: This University Health System is
affiliated with over 150 satellite clinical sites. 20 sites delivering mostly adult
primary care were invited to participate. Individuals from 14 sites completed
TTS training. Initial assessment of tobacco use (Current/Former/Never) was
excellent (>99%) across all clinical sites, including those who did not particpate
in TTS training. However, pack-years were recorded on average less that 40%
of the time and quit dates for former smokers were recorded less than 30% of
the time at baseline. After training clinic staff in the TTS course, and regular
ongoing feedback to clinical directors, we observed a significant initial increase
in accurate recording of pack-years and quit dates (two points of emphasis) for
all sites involved in the project, as well as referals to tobacco counselling. Over
this time, unfortunately we did not detect an increase in the rate of prescription
of tobacco pharmacotherapy. The There was a gradual increase in the the
number of referrals for lung cancer screening Cts increased from an average of
30 per month to an average of over 70. Conclusion: This project to disseminate
the skills of a TTS training course to clinics within a large University Health
System has led to modest improvements in overall practices and demonstrated
areas where additional improvements are needed.
Keywords: tobacco cessation, quality improvement, screening
OA04: EPIDEMIOLOGY AND PREVENTION OF LUNG CANCER
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
OA04.05 CHRONIC INFLAMMATION, NSAIDS AND THE RISK OF
LUNG CANCER DEATH
Marisa Bittoni 1 , David Carbone 2 , Randall Harris 3
1 The Ohio State University, Columbus/United States of America, 2 Medical Oncology,
The Ohio State University, Columbus/OH/United States of America, 3 The Ohio State
Unversity, Columbus/OH/United States of America
This abstract is under embargo until December 5, 2016 at 07:00 CET.
OA04: EPIDEMIOLOGY AND PREVENTION OF LUNG CANCER
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
OA04.06 EXAMINING PLEIOTROPIC ASSOCIATIONS OF GENETIC
RISK VARIANTS FOR CHRONIC OBSTRUCTIVE PULMONARY
DISEASE WITH LUNG CANCER RISK
Lori Sakoda 1 , Khanh Thai 1 , Nareg Roubinian 2 , Carlos Iribarren 1 , Catherine
Schaefer 1 , Neil Risch 3 , Laurel Habel 1 , Charles Quesenberry Jr. 1 , Eric Jorgenson 1
1 Division of Research, Kaiser Permanente Northern California, Oakland/CA/United
States of America, 2 Department of Pulmonary Medicine and Critical Care, Kaiser
Permanente Northern California, Oakland/CA/United States of America, 3 Institute
for Human Genetics, University of California San Francisco, San Francisco/CA/
United States of America
Background: Tobacco smoke is the primary cause of chronic obstructive
pulmonary disease (COPD) and lung cancer, and among smokers, COPD is
associated with increased lung cancer risk. However, fewer than 30% of
smokers are diagnosed with either disease, suggesting that genetic factors also
influence the pathogenesis of both diseases. Despite the plausibility for shared
genetic predisposition, knowledge about pleiotropy between COPD and lung
cancer is limited. Methods: Using the Genetic Epidemiology Research on Adult
Health and Aging cohort established at Kaiser Permanente Northern California
(KPNC), an integrated healthcare system, we examined non-Hispanic white
smokers aged ≥40 years diagnosed with lung cancer (n=489), including those
with COPD (n=243) or without COPD (n=174), and neither disease (n=26,553)
through January 31, 2014. Those with lung cancer were identified from KPNC
Cancer Registry data. Those with COPD were identified from electronic health
record data, requiring at least one hospitalization with a principal discharge
diagnosis or two outpatient visits with a diagnosis of chronic bronchitis,
emphysema, or COPD (ICD-9 codes: 491.*, 492.*, 496.*). We examined 16
single nucleotide polymorphisms (SNPs) in 10 risk loci identified previously
for COPD or airflow obstruction by genome-wide association studies (1q41,
4q22.1, 4q31.21, 5q32, 6p21.32, 11q22, 14q32, 15q25.1, 16p11.2, 19q13) for their
associations with lung cancer risk, overall and stratified by COPD. SNPs were
examined individually and also jointly as an unweighted 16-SNP risk score.
Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using
logistic regression, adjusted for age, sex, pack-years of smoking, and principal
components of genetic ancestry. Results: Only two SNPs at 15q25.1, a risk locus
also known for lung cancer and nicotine dependence, were associated with
overall lung cancer risk: rs8034191 (per-allele OR=1.22, 95% CI: 1.07-1.39, p=0.003)
and rs12914385 (per-allele OR=1.23; 95% CI: 1.08-1.40, p=0.002). In stratified
analyses, associations were marginally stronger for lung cancer without COPD
(rs8034191: OR=1.36, 95% CI: 1.09-1.69; rs12914385: OR=1.24, 95% CI: 1.00-1.54)
than lung cancer with COPD (rs8034191: OR=1.09, 95% CI: 0.90-1.31; rs12914385:
OR=1.17, 95% CI: 0.97-1.40). The 16-SNP risk score was suggestively associated
with overall lung cancer risk (highest vs. lowest quintile: OR=1.31, 95% CI: 0.97-
1.76), with the magnitude of association somewhat stronger for lung cancer
with COPD (OR=1.28, 95% CI: 0.84-1.97) than without COPD (OR=1.16, 95%
CI: 0.72-1.88). Conclusion: Our preliminary results provide minimal evidence
of pleiotropic associations of identified genetic variants for COPD with lung
cancer risk, although analyses are limited by the number of lung cancer patients
examined.
Keywords: lung cancer, pleiotropy, Chronic obstructive pulmonary disease
OA04: EPIDEMIOLOGY AND PREVENTION OF LUNG CANCER
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
OA04.07 CLINICAL CHARACTERISTICS OF LUNG ADENOCARCINOMA
IN THE YOUNG: RESULTS FROM THE GENOMICS OF YOUNG LUNG
CANCER STUDY
Barbara Gitlitz 1 , Anna Wu 1 , Marisa Bittoni 2 , Bonnie Addario 3 , Alicia Sable-
Hunt 4 , Mark Jennings 1 , Silvia Novello 5 , Tiziana Vavala 6 , Ruthia Chen 7 , Deborah
Morosini 8 , Geoffrey Oxnard 7 , S. Lani Park 1
1 University of Southern California Keck School of Medicine, Los Angeles/CA/United
States of America, 2 Ohio State University, Columbus/OH/United States of America,
3 Bonnie J. Addario Lung Cancer Foundation, San Carlos/United States of America,
4 Addario Lung Cancer Medical Institute, San Carlos/United States of America,
5 Department of Oncology, University of Turin, Turin/Italy, 6 University of Turin,
Turin/Italy, 7 Dana-Farber Cancer Institute, Boston/MA/United States of America,
8 Foundation Medicine Inc., Cambridge/MA/United States of America
Background: Background: Lung cancer is increasingly recognized as a
heterogeneous disease comprised of genomically defined subtypes with
distinct targetable genomic alterations. However, it is unknown whether
established lung cancer risk factors differ between these genomically
distinct subtypes. In this study of the genomics of young lung cancer
(GoYLC), we present preliminary results of lifestyle risk factors by specific
genomic alteration to better characterize lung cancer in the young. Methods:
Methods: Beginning in July of 2014, patients diagnosed with a bronchogenic
lung cancer under the age of 40 were recruited to the GoYLC study. Informed
consent was obtained in-person and virtually (online), allowing patients to
participate globally, regardless of proximity to study sites (https://www.
openmednet.org/site/alcmi-goyl). To date, this study has accrued a total of
101 cases, of which 85 are adenocarcinoma (AC). Stage 4 AC is the focus of this
analysis. Results: Results: Among the 63 stage 4 AC cases, the most common
genomic alterations were ALK rearrangements (n=28; 44% of stage 4 AC
cases) and EGFR mutations (n=17; 27%) while the other genomic alterations
(n=18; 29%) include ROS1, BRCA2, HER2, P53, RET and ATM. The prevalence
of active smoking and/or exposure to passive smoking was highest among
those with ALK (64%), intermediate for those with EGFR (47%) and lowest
for those with other genomic alterations (39%). However, the prevalence of
only active smoking was lowest among those with ALK (28%), followed by
EGFR (35%) and highest for those with other genomic alterations (39%). The
majority of patients with ALK rearrangements or EGFR mutations reported no
family history of lung cancer (82% and 88%, respectively), compared with 67%
among those with other genomic alterations. Conclusion: Conclusion: These
preliminary results suggest that lifestyle characteristics and family history in
young lung cancer patients may differ by genomic alteration. Passive smoke
exposure was more prevalent among those with ALK rearrangements or EGFR
S132 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017