Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
the management of adverse events, both strategies were similar in the public
perspective (USD 94.15 for gefitinib versus USD 98.21 for erlotinib); however,
gefitinib costs were lower than erlotinib (USD 625.27 versus USD 941.32,
respectively) in the private sector. Conclusion: First line treatment with
gefitinib was dominant in comparison with erlotinib for NSCLC patients with
EGFR mutation in both public and private sectors in Brazil.
Keywords: Erlotinib, NSCLC, gefitinib, economic evaluation
POSTER SESSION 3 – P3.07: REGIONAL ASPECTS/HEALTH
POLICY/PUBLIC HEALTH
Other – Geographical Differences –
WEDNESDAY, DECEMBER 7, 2016
P3.07-011 GEOGRAPHICAL VARIATION IN THE USE OF
RADIOTHERAPY AND SURGICAL RESECTION FOR TREATMENT OF
NON-SMALL CELL LUNG CANCER IN ENGLAND
Daniela Tataru 1 , Katie Spencer 2 , Ruth Jack 1 , Andrew Bates 3 , Andrzej
Wieczorek 4 , Michael Lind 4 , Margreet Lüchtenborg Lüchtenborg 1
1 Public Health England, London/United Kingdom, 2 Cancer Epidemiology Group,
University of Leeds, Leeds/United Kingdom, 3 University Hospital Southampton
NHS Foundation Trust, Southampton/United Kingdom, 4 Hull York Medical School,
University of Hull, Cottingham/United Kingdom
Background: Despite global improvements in survival non-small cell lung
cancer (NSCLC) remains lethal, with 20% five year survival in a limited number
of developed nations. Fit, early stage NSCLC patients can be offered curative
treatment, using surgery or radical radiotherapy. Geographical variation in
surgery usage in England has previously been demonstrated. We aimed to
further investigate this variation, incorporating all curative treatments and
considering associated survival. Methods: Information on 143,886 patients
diagnosed with a first NSCLC between April 2009 and December 2013 in
England was extracted from the national cancer registration dataset linked
to radiotherapy treatment and Hospital Episode Statistics data. In England
Clinical Commissioning Groups (CCG) are the statutory bodies responsible
for the planning and commissioning of health care services for their local
area. We calculated the proportion of patients receiving curative treatment
in each CCG, and created quintiles from the resulting distribution. Logistic
regression was used to assess the effect of age, sex, stage, comorbidity,
performance status and socio-economic deprivation on curative treatment
usage. Multivariable Cox regression models were used to analyse survival
in relation to curative treatment quintile. Results: Overall, 29,580 (20.6%)
NSCLC patients received curative treatment: 20,177 (14.0%) NSCLC patients
underwent resection and 9,403 (6.5%) received radical radiotherapy. The
proportion of patients receiving curative treatments ranged from 11.8% to
31.7% across English CCGs and decreased with advancing age (p < 0.001),
increasing stage (p < 0.001) and worsening performance status (p < 0.001).
The proportion of patients receiving curative treatment was greater for
females compared with males (p < 0.001). The absolute risk of dying within
5 years ranged from 90% in the lowest treatment quintile to 85% in the
highest. Increasing curative treatment rates were associated with lower
mortality (p < 0.001), with an adjusted HR of 0.93 (95% CI 0.92 to 0.95) in
the highest treatment quintile compared with the lowest. Conclusion:
Despite adjustment for case-mix variables we demonstrated that significant
variation in the use of curative treatment for NSCLC persists across CCGs with
increasing curative treatment rates associated with lower mortality. There is
a need to further explore the factors driving this variation in order to guide
changes in care which may deliver improved outcomes.
Keywords: non-small cell lung cancer, resection, radical radiotherapy, England
POSTER SESSION 3 – P3.07: REGIONAL ASPECTS/HEALTH POLICY/PUBLIC HEALTH
OTHER – GEOGRAPHICAL DIFFERENCES –
WEDNESDAY, DECEMBER 7, 2016
P3.07-012 DISPARITIES IN GUIDELINE-CONCORDANT TREATMENT
FOR NODE-POSITIVE NON-SMALL CELL LUNG CANCER FOLLOWING
SURGERY
Paul Speicher, Zachary Fitch, Brian Gulack, Babatunde Yerokun, Matthew
Hartwig, David Harpole, Thomas D’Amico, Betty Tong
Surgery, Duke University, Durham/NC/United States of America
Background: To examine guideline concordance across a national sample
and to determine the relationship between socioeconomic factors, use of
recommended post-operative therapy, and outcomes for patients with pN1
or pN2 non-small cell lung cancer (NSCLC). Methods: All margin-negative
pT1-3 N1-2 M0 NSCLC treated with lobectomy or pneumonectomy without
induction therapy in the National Cancer Data Base (NCDB) between
2006-2011 were included for analysis. Use of guideline-concordant adjuvant
therapy, defined as chemotherapy for pN1 disease and chemoradiation
therapy for pN2 disease, were examined regarding pathologic, demographic,
and socioeconomic factors. Multivariable regression models were developed
to estimate predictors of guideline adherence and outcomes. Survival was
estimated using the Kaplan-Meier method. Results: A total of 9,300 patients
were identified. Of these, 7,137 had pN1 disease and 2,163 had pN2 disease.
Guideline-concordant adjuvant therapy was utilized in 4,477 (62.7%) pN1
patients and 646 (29.9%) pN2 patients. After multivariable adjustment,
patient age (OR 0.59 per decade, 95% confidence interval [CI]: 0.56-0.63),
uninsured status (OR 0.52, 95%CI:0.39-0.71), N2 disease (OR 0.21, 95%CI:0.18-
0.23), pneumonectomy (OR 0.75, 95%CI:0.65-0.86), longer postoperative
length of stay (OR 0.96/day, 95%CI:0.95-0.97) and unplanned readmission
(OR 0.76, 95%CI:0.61-0.95) were associated with significantly worse guideline
concordance, while higher education levels (OR 1.07 per quartile, 95%CI:1.01-
1.14) and increasing T-stage (OR 1.08, 95%CI:1.01-1.16) were associated with
significantly higher concordance. Overall, patients treated with guidelineconcordant
therapy had superior survival (5-year survival: 50.4 vs. 35.3%,
p