Journal Thoracic Oncology

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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-004 IS THERE ANY ROLE OF RESIDENTIAL RADON IN NON SMALL CELL LUNG CANCER (NSCLC) PATIENTS HARBORING MOLECULAR ALTERATIONS? Laura Mezquita 1 , Amparo Benito 2 , Maria Eugenia Olmedo 3 , Pablo Reguera 3 , Ainhoa Madariaga 3 , Maria Villamayor 3 , Silvia Patricia Cortez 3 , Luis Gorospe 4 , Almudena Santon 2 , Sagrario Mayoralas 5 , Raul Hernanz 6 , Alberto Cabanero 7 , Alfredo Carrato 3 , Pilar Garrido 3 1 Medical Oncology Department, Gustave Roussy, Villejuif/France, 2 Pathology Department, University Hospital Ramon Y Cajal, Madrid/Spain, 3 Medical Oncology Department, University Hospital Ramon Y Cajal, Madrid/Spain, 4 Radiology Department, University Hospital Ramon Y Cajal, Madrid/Spain, 5 Pulmonary Department, University Hospital Ramon Y Cajal, Madrid/Spain, 6 Radiation Oncology Department, University Hospital Ramon Y Cajal, Madrid/Spain, 7 Thoracic Surgery Department, University Hospital Ramon Y Cajal, Madrid/Spain Background: Radon gas is the first cause of lung cancer in non-smoking population. The World Health Organization (WHO) recommends radon concentration lower than 100 Bq/m3. In recent years, most of the advances in personalized therapy in NSCLC patients also occurred in nonsmokers. Furthermore, limited information is available about the clinical and pathological characteristics in patients exposed to radon gas. We hypothesized that residential radon could be associated to some specific pathological and molecular alterations in NSCLC patients. Methods: Prospective study of a cohort of NSCLC patients harbouring molecular alterations (EGFR, BRAF mutations (m), ALK and ROS1 rearrangements (r)) in our centre, between September 2014 and October 2015. A radon detector alpha-track was given to each patient to measure residential radon concentration for 3 months; it was analysed using optical microscopy. We collected demographic information, smoking history, environmental exposure and clinical characteristics. The pathologic characteristics were prospectively revised by a lung cancer pathologist, including histology pattern, grade and inflammatory infiltrate. EGFR and BRAF mutation (m) were analyzed using quantitative real-time polymerase chain reaction (PCR) and ALK and ROS1 rearrangement by fluorescence in situ hybridization (FISH). Data was analyzed using IBM SPSS v.20. Results: 60 detectors were delivered (10% missing), 48 patients were evaluated (89.6% living in Madrid). Median age 66.5 (29- 82); 33 (68.8%) females; 33 non-smokers (31.3% passive smokers and 35.4% childhood exposure) and 3 (6.3%) light smokers. 100% adenocarcinoma (35.4% mixte, 18.8% acinar, 10.4% solid, 8.3% papillary, 8.3% micropapilllary, 8.4% others and 10.4% unknown); EGFRm 36 patients, ALKr 10 patients and BRAFm 2 patients. Home characteristics measured: 79.2% flat (89.1% measurement at bedroom); building material: 89.6% bricks. Median length of stay was 28 years (2-55). Median height of house 2 floors (0-15). Median of radon concentration: 104 Bq/m3 (42- 915); 60.42% over WHO recommendation. By molecular alteration: EGFRm median 96 Bq/m3 (42-915), ALKr median 116 (64-852) and BRAFm median 125 (125). A significant association was observed between non-EGFR mutation and concentration over the WHO recommendation (p=0.044). In univariant analysis, radon concentration was associated with non-mucinous histology and low tumoral grade (p=0.033 and p=0.023, respectively). Conclusion: Our final results have shown no consistent association between residential radon and molecular alterations in NSCLC patients, but a trend has been suggested in ALKr and BRAFm. Large multicenter studies are needed to confirm this hypothesis. Keywords: Radon, molecular alteration, NSCLC POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-005 FIRST OF ITS KIND STUDY IN INDIA FINDS THAT GOVERNMENT’S BAN ON GUTKA (HIGHLY POPULAR SMOKELESS TOBACCO PRODUCT) DID NOT INCREASE SMOKING AT ALL Gaurav Kumar 1 , Pradeep Kumar 2 1 Community Medicine, Gmers Medical College, Ahmedabad/India, 2 Gmers Medical College, Ahmedabad/India Background: India with 11.2%(111.9 million) of world’s smokers has 2 nd largest population at elevated risk of lung cancer. Almost twice, 206 million(GATS, 2010), are Smokeless tobacco(ST) users in India, highest globally. Supreme Court of India observed that gutka and pan-masala are food products. Beginning in 2012, almost all state governments in India banned gutka and pan-masala containing tobacco. APPREHENSION was raised that ban on ST products will cause switching to smoking by huge ST user population vastly increasing risk of lung-cancer in India. This ban provided natural experiment on which this observational research studied how ban on popular ST products alters pattern of tobacco-use, especially smoking. Findings are expected to be strategically significant to inform future policies. Methods: Questionnaire of Global Adult Tobacco Survey-India(2010), developed by WHO,CDC and Govt. of India was modified to answer research questions and accommodate retrospective-cohort study design. Through 2-step randomization process, 500 households were sampled from Delhi. Participants were adults and interviewed during March-June,2016 comprehensively, including tobaccouse currently and before gutka-ban. Inbuilt mechanisms in standardized questionnaire cross-validated self-report and minimised recall bias. Data was entered into SPSS and statistically analysed. Results: 94% of 500 households visited agreed to participate. 73.4%of pre-ban gutka-users switched to twin-sachet (pan-masala and chewing-tobacco sold separately by gutka-manufacturers to circumvent law). Delhi’s order bans all ST products. But, except premixed gutka, remaining ST products are freely available and consumed. 21.8%switched to khaini or other ST products. A large fraction switched from singledose sachets to multidose sachet. Interestingly, 96.2%respondents believed tobacco as very harmful(84.6%) or somewhat harmful(11.6%). However, only 18.6%gutka users attempted quitting after ban. 4.8%successfully quitted. In our sample, we DIDNOT find anyone switching to smoking due to gutka unavailability. On an opposite thought, one may expect, ban on an ST product(Gutka) will increase awareness and motivate smokers to quit as spillover effect. But it wasn’t observed either. Conclusion: In absence of strong quitting promotion campaign, ban on selective tobacco products has limited role in changing prevalence of tobacco use. If selective ST products are banned, ST users preferably switch to other available ST products, BUT NOT to smoking. As majority ST users switched instead of quitting (after gutka-ban without simultaneous quitting campaign), we may logically conclude that effective ban on all ST products may lead ST users to switch to less favourable option of smoking. This is, however, subject to verification by similar study if there is ever effective ban on all ST products. Keywords: Smokeless Tobacco, Gutka ban, smoking, GATS POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-006 INTERSTITIAL LUNG DISEASES ARE AN ANTECEDENT OF LUNG CANCER Wonil Choi Department of Internal Medicine, Keimyung University School of Medicine, Daegu/ Korea, Republic of Background: Diffuse pulmonary fibrosis may progress into lung cancer through continuous accumulation and rapid proliferation of fibroblasts and repeated epithelial injury. Repetitive injury and repair can lead to multiple genetic alterations affecting cellular growth, differentiation, and survival, which may elicit malignant potential in the injured area. Diffuse pulmonary fibrosis appears on chest images through expression of bilateral reticular or reticulonodular opacities, called interstitial lung diseases. The clinical significance of these diseases remains poorly understood. To investigate whether interstitial lung diseases increase lung cancer incidence in a cohort of patients from a national population. Background: Diffuse pulmonary fibrosis may progress into lung cancer through continuous accumulation and rapid proliferation of fibroblasts and repeated epithelial injury. Repetitive injury and repair can lead to multiple genetic alterations affecting cellular growth, differentiation, and survival, which may elicit malignant potential in the injured area. Diffuse pulmonary fibrosis appears on chest images through expression of bilateral reticular or reticulonodular opacities, called interstitial lung diseases. The clinical significance of these diseases remains poorly understood. To investigate whether interstitial lung diseases increase lung cancer incidence in a cohort of patients from a national population. Results: A nationwide retrospective cohort study using Korean Health Insurance Review and Assessment Service data, including 13,666 patients with interstitial lung disease (6.4% with concomitant idiopathic pulmonary fibrosis) diagnosed January–December 2009. The end of follow-up was June 31, 2014. Up to four matching chronic obstructive pulmonary disease controls with and without concomitant interstitial lung disease (8,012 cases) were selected to compare the lung cancer high-risk group. Lung cancer was counted after diagnosis of interstitial lung disease, idiopathic pulmonary fibrosis, or chronic obstructive pulmonary disease. Conclusion: The incidence of lung cancer was 126.9 cases per 10,000 person-years (2,732 cancers) in the chronic obstructive pulmonary disease group, 156.6 (809 cancers) in the interstitial lung disease group, and 370.3 (967 cancers) in the chronic obstructive pulmonary disease with interstitial lung disease group. Among various interstitial lung disease definitions, idiopathic pulmonary fibrosis showed the highest lung cancer incidence. A total of 112 of the 879 patients with idiopathic pulmonary fibrosis developed lung cancer, an incidence of 381 cases per 10,000 person-years. Interstitial lung diseases have high potential to develop into lung cancer even S232 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 when combined with chronic obstructive pulmonary disease. Keywords: lung cancer, Incidence, interstitial lung disease POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-007 A CROSS-SECTIONAL STUDY ON TOBACCO CONSUMPTION PATTERN AMONG AUTO RICKSHAW DRIVERS IN CHENNAI CITY, TAMIL NADU, INDIA Delfin Lovelina Francis Public Health Dentistry, Tagore Dental College and Hospital, Chennai/India Background: Tobacco use is a major preventable cause of premature death and diseases, currently leading to five million deaths worldwide which are expected to raise over eight million deaths worldwide by 2030. India is the second largest consumer of tobacco in the world. Tobacco use is a leading cause of deaths and disabilities in India as well, killing about 1.2 lakh people in 2010. About 29% of adults use tobacco on a daily basis and an additional 5% use it occasionally. This study is contemplated with an aim to assess the prevalence of tobacco consumption and the associated factors involved in its consumption, as this group of the population is under constant pressure and account for the workforce of the country. So through this study we could be able to know * The reasons of consumption. * Amount of consumption *Awareness of ill effect of tobacco consumption* Out of Pocket expenditure. Methods: ACross sectional descriptive study was conducted among Auto Rickshaw Drivers in Chennai City.Auto drivers who were working for more than two years and present on the day of examination and who were willing to participate in the study were included.Cluster random sampling technique was used. 400 samples were selected from 40 auto stands of various parts of Chennai City.Data was collected using a Survey Proforma which comprised of a Questionnairewhich can assess the frequency of consumption, age of initiation, the amount of consumption, mental stress, economic factors, any past history of disease and most importantly the awareness towards oral cancer.The data recorded was transferred and analysed using SPSS version 20.Chi- square test was used to test the significance between groups. Results: Prevalence among auto rickshaw drivers for consumption of tobacco products was very high (87%). Auto rickshaw drivers were mostly used tobacco in the form of Gutkha (72%) and bidi (40%) in comparison to other products. In the opinion of auto rickshaw drivers increase in tax may reduce it consumption and the majority of drivers (70%) think that tobacco must be banned. Conclusion: Prevalence of tobacco use among auto rickshaw drivers was very high. Mostly they use tobacco products to reduce stress, to be awake or to remove nervousness but a large number of participants also use them without any reason. Almost one half of the study population was suffering from tobacco related diseases like cough, ulcer on mouth, lung disorder. They are in definite need of tobacco cessation activities. Keywords: Tobacco, Awareness, Prevalence, Addiction. response was recorded. Random sampling method was used and data was collected from a cross-sectional survey. The surveywas conducted between January and February 2015. Statistical analysis was done using SPSS version 17 and Logistic regression model was used to identify possible associations with tobacco smoking status. The level of significance was Results: A total of 259answered the questionnaire of which 29% declared to be smokers. About 53% of the males have smoked at least once in their life and the age of cigarette initiation was 16-17 years for 28% of the sample.76%considered health professionals as behavioural models for patients, and 96% affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 87% heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. 93% of the sample agreed that health professionals should receive specific training on smoking cessation according to while 6% were of the opposite opinion. Conclusion: The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in medicine and dentistry, their key role both as advisers and behavioural models, and the limited tobacco training offered in the curriculum. In the field of public health, tobacco screening, and intervention is one of the most effective clinical preventive services. Keywords: Medical students, smoking habits, oral cancer POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-009 SMOKING AND LUNG CANCER: DATA FROM THE SINGLE CENTER IN ALBANIA Daniela Xhemalaj 1 , Fatmir Caushi 2 , Ilir Peposhi 3 , Elona Hila 3 , Gisela Pumo 1 , Asela Hasa 1 , Hasan Hafizi 3 1 Pathology, University Hospital of Lung Diseases, Sauk/Albania, 2 Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania, 3 Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania Background: Albania is a country with a high prevalence of smoking but a national cancer registry has not been initiated yet and data on lung cancer are scarce. Methods: Aim - Methods: In 2010-2014, 1254 patients presented to our hospital with either symptoms or an abnormal finding in their chest X-ray and were diagnosed with lung cancer. This is a descriptive retrospective study, reporting data on the histological type of cancer and smoking history Results: Results: Of the 1254 patients, 79% (n= 1001) were men and 21% (n=253) women . Age range was (16-89), with mean age in men 62.4 ±8,5 and in women 58±10,2. Diagnosis was confirmed by histology [table 1] : Regarding NSCLC, 78% of patients had an advanced stage (III and IV). Only 268 patients were non-smokers, 126 were ex-smokers and the remaining 67 % (n=860) were current smokers with high exposure (92 pack/years). Day hospital avarage is 7 day,and day range was(1-21) with SD± 6.4. Performance status was:60.2% improved,35.2% idem,3.3% dead in hospital. POSTER SESSION 1 - P1.01: EPIDEMIOLOGY, TOBACCO CONTROL AND CESSATION/ PREVENTION TOBACCO, RADON, AIR POLLUTION, OTHER RISK FACTORS – MONDAY, DECEMBER 5, 2016 P1.01-008 KNOWLEDGE, ATTITUDES, AND SMOKING BEHAVIOURS AMONG DENTAL AND MEDICAL STUDENTS IN CHENNAI, TAMIL NADU, INDIA Delfin Lovelina Francis Public Health Dentistry, Tagore Dental College and Hospital, Chennai/India Background: Tobacco use continues to be the leading cause of preventable disease and it is responsible for more than 5 million deaths each year worldwide. Despite this, there are still 650 million smokers in the world. The prevalence of smoking among adults accounts for approximately 25% deaths annually. smoking remains the main cause of mortality and morbidity in the developing nations. Healthcare professionals have an important role to play both as advisers influencing smoking cessation and as role models. However, many of them continue to smoke. Several studies have demonstrated the efficacy of smoking cessation programs and the importance of physician’s advice to their patients. The aims of the present study are as follows: (i) to evaluate smoking prevalence, knowledge and attitudes, and tobacco cessation training (ii) to examine the difference between smokers and nonsmokers; Methods: A structured questionnaire consisting of 14 questions related to tobacco/smoking habits, cessation training and role of health professionals in tobacco control were asked to the study population and their men women Squamous cell carcinoma 56% (n=560) 11% (n=27) Adenocarcinoma 22% (n=220) 72% (n=183) Small cell others Total 15%(n=150) 5% (n=13) 7% (n=71) 12% (n=30) 100% (n=1001) 100% (n=253) Conclusion: In Albania,lung cancer is an increasing pathology (p
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