Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Alona Zer 1 , Mor Moskovitz 2 , David Hwang 3 , Anat Hershko-Klement 4 , Ludmila
Fridel 1 , Grzegorz Korpanty 3 , Elizabeth Dudnik 1 , Nir Peled 1 , Tzippy Shochat 1 ,
Natasha Leighl 5 , Geoffrey Liu 6 , Ronald Feld 6 , Ronald Burkes 4 , Mira Wollner 2 ,
Ming Tsao 7 , Frances Shepherd 8
1 Rabin Medical Center, Petach Tikva/Israel, 2 Rambam Medical Center, Haifa/Israel,
3 Princess Margaret Cancer Centre, University Health Network (UHN), Toronto/ON/
Canada, 4 Mount Sinai Hospital, Toronto/ON/Canada, 5 Medical Oncology, Princess
Margaret Cancer Centre, Toronto/Canada, 6 Princess Margaret Cancer Centre,
Toronto/Canada, 7 Departments of Pathology, Princess Margaret Cancer Centre and
University of Toronto, Toronto/Canada, 8 Princess Margaret Cancer Centre, Toronto/
ON/Canada
Background: Patients with lung cancer are at increased risk for venous
thromboembolism (VTE), particularly those receiving chemotherapy. It is
estimated that 8-15% of patients with advanced non-small cell lung cancer
(NSCLC) experience a VTE in the course of their disease. The incidence in
patients with specific molecular subtypes of NSCLC is unknown. We
undertook this review to determine the incidence of VTE in patients with
ALK-rearranged NSCLC. Methods: We identified all patients with ALKrearranged
NSCLC, diagnosed and/or treated at the Princess Margaret Cancer
Centre (PM CC) in Canada between July 2012 and January 2015. Retrospective
data were extracted from electronic medical records. We then included a
validation cohort comprising all consecutive patients with ALK-rearranged
NSCLC treated in two tertiary centers in Israel. Results: Within the PM CC
cohort, of 55 patients with ALK-rearranged NSCLC, at a median follow-up of
22 months, 23 (42%) experienced VTE. Patients with VTE were more likely to
be Caucasian (p=0.006). The occurrence of VTE was associated with a trend
towards worse prognosis (overall survival HR=2.88, p=0.059). Within the
validation cohort (N=43), VTE rate was 28% at a median follow-up of 13
months. Combining the cohorts (N=98) the VTE rate was 36%. Patients with
VTE were younger (age 52 vs 58, p=0.04) and had a worse ECOG performance
status (p=0.04). VTE was associated with shorter OS (HR=5.71, p=0.01).
they or their loved one experienced during and after treatment, as well as 5+
years after diagnosis. They also indicated which of these side-effects were
most problematic during those time periods. Respondents were also for
demographic information and for open-ended responses about their unmet
needs during care and follow-up. Results: Respondents indicated a high
rate of side effects, with over 95% reporting at least one. Importantly, both
patients and caregivers reported that physical side effects were significantly
more problematic during treatment but that emotional side effects were
more problematic after treatment and in the long-term. Patients rated
anxiety, fatigue, and shortness of breath as the most problematic short and
long-term post-treatment side effects, with 18-29% of patients indicating
these items at a particular time period. During treatment, gastrointestinal
issues including constipation (18%), diarrhea (17%), and nausea (14%) were
also identified as highly problematic side effects by the patients. Caregivers
reported similar effects but also rated pain as problematic across all time
periods (15-24%) and identified loss of appetite (28%) and weight loss (25%)
during treatment. When questioned about unmet needs during treatment
and survivorship, respondents frequently commented that their treatment
team focused on treatment and survival and not on managing side effects.
Conclusion: Side effect management is a clear unmet need for lung cancer
patients and to help support their caregivers. Our data show high levels of
emotional and physical side effects and a perceived lack of support for proper
management. Notably, emotional side effects are prevalent after treatment
for lung cancer into long-term survivorship and are frequently cited as the
most problematic issue for those no longer in active treatment.
Keywords: supportive care, side effects, survivorship, lung cancer
OA21: PALLIATIVE AND SUPPORTIVE CARE FOR LUNG CANCER PATIENTS
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA21.05 WET M1A NON-SMALL CELL LUNG CANCER: IS IT POSSIBLE
TO PREDICT RECURRENCE OF PLEURAL EFFUSION?
Fernando Abrao 1 , Igor Abreu 1 , Mariana Oliveira 2 , Geisa Viana 2 , Riad Younes 1
1 Oncology Center Hospital AlemÃo Oswaldo Cruz, SÃo Paulo/Brazil, 2 Santa
Marcelina Medical School, SÃo Paulo/Brazil
Conclusion: We found the rate of VTE in our ALK-rearranged cohort is 3-5-fold
higher than previously reported for the general NSCLC population. This
warrants confirmation in larger cohorts.
Keywords: ALK, VTE, Thrombosis, NSCLC
OA21: PALLIATIVE AND SUPPORTIVE CARE FOR LUNG CANCER PATIENTS
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA21.03 UNMET NEEDS IN PHYSICAL AND EMOTIONAL SIDE
EFFECTS DURING LUNG CANCER TREATMENT AND SURVIVORSHIP
Jennifer King 1 , Jamal Bankhead 2 , Maureen Rigney 3
1 Science & Research, Lung Cancer Alliance, Washington/DC/United States of
America, 2 Medical Outreach, Lung Cancer Alliance, Washington/DC/United States
of America, 3 Support Services, Lung Cancer Alliance, Washington/DC/United States
of America
Background: Previous research has shown that supportive care needs in lung
cancer patients are high and that this population may have significantly
more unmet care needs than other cancer patients. Our goals for this study
were to determine the most prevalent and problematic side-effects of lung
cancer and lung cancer treatment in our community and to understand
where both patients and caregivers felt there were unmet needs. Methods:
A Community Needs Assessment survey was distributed to lung cancer
patients and caregivers electronically between 11/9/2015 and 2/8/2016. 820
people responded, including 471 patients/survivors and 349 caregivers, 181
of whom identified as the primary caregiver. The overall completion rate
was 72.6%, similar for both groups. Respondents identified all side effects
Background: Pleural and oncological treatment options for malignant
pleural effusion (MPE) are increasing and hence, more accurate prognosis
at presentation may help to identify patients with the higher risk of pleural
recurrence, in order to individualize more intensive treatment strategies.
The aim of this study was to identify predictors of malignant pleural effusion
recurrence in patients with M1a non-small cell lung cancer (NSCLC) Methods:
All patients with NSCLC and MPE submitted to pleural palliative procedures
including simple pleural drainage, videothoracoscopic pleural drainage,
pleurodesis and indwelling pleural catheter were enrolled in a prospective
study between 2014 and 2015, and divided into two groups. Group I included
patients who had pleural recurrence, and Group II with no pleural recurrence
after the palliative procedures. Prognostic factors for pleural recurrence were
identified by univariate analysis, using Fisher’s exact test for the analysis
of categorical variables and Student’s t test for quantitative variables.
Subsequently the significant variables were entered into a multivariate
logistic regression analysis (with p< 0.05 considered significant). The cutoff
points for any significant continuous variables were determined by receiver
operating characteristics (ROC) analysis. Results: A total of 82 patients
were included in the analysis. Median follow-up time for surviving patients
was 81 days (range 1 to 1070 days). There were 15 patients (18.3%) in Group I
and 67 patients (81.7%) in Group II. Univariate analysis of factors affecting
postoperative recurrence were: adenosine deaminase concentration in
pleural fluid < 16 mg/dl (p=0.04), albumin concentration in pleural fluid < 2.4
mg/dl (p= 0.03), administration of second-line palliative chemotherapy (p=
0.018) and type of procedure (simple pleural drainage vs. videothoracoscopic
pleural drainage, pleurodesis and indwelling pleural catheter) (p= 0.023).
At the multivariate analysis, only the type of procedure (simple pleural
drainage)( p= 0.031) was identified as independent predictor of recurrence.
Conclusion: In our cohort of NSCLC patients with MPE submitted to pleural
palliative procedures, simple pleural drainage was the only significantly factor
associated with recurrence of MPE. The identification of this factor may assist
the choice of the optimal palliative technique, at the first episode of MPE in
NSCLC patients. Definitive procedure as pleurodesis is recommended, the
indwelling pleural catheter or videothoracoscopic drainage are options for
patients whom lung are trapped.
Keywords: Carcinoma, Non-Small-Cell Lung, palliative care, recurrence
OA21: PALLIATIVE AND SUPPORTIVE CARE FOR LUNG CANCER PATIENTS
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA21.06 TURNING BEST SUPPORTIVE CARE INTO ACTIVE CARE. A
S166 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017