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Jovanoski N, Bowes K, Brown A, Belleli R, Di Maio D, Chadda S, Abogunrin S. Survival and quality-of-life outcomes in early-stage NSCLC patients: a literature review of real-world evidence. Lung Cancer Manag 2023; 12:LMT60. [PMID: 37693293 PMCID: PMC10485735 DOI: 10.2217/lmt-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Aim Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Methods Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Results Disease-free proportion decreased in stage III vs stage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Conclusion Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.
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Affiliation(s)
- Nick Jovanoski
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Kathleen Bowes
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Audrey Brown
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Rossella Belleli
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Danilo Di Maio
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Shkun Chadda
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Seye Abogunrin
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
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Budget Impact di afatinib per il trattamento in prima linea del Non Small Cell Lung Cancer (NSCLC) con mutazioni non comuni EGFR. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2022; 9:22-29. [PMID: 36628318 PMCID: PMC9768614 DOI: 10.33393/grhta.2022.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/04/2022] [Indexed: 01/13/2023] Open
Abstract
Background: The current clinical practice for patients affected by Non-Small Cell Lung Cancer (NSCLC) with uncommon mutation is based on afatinib and osimertinib, second and third generation of Tyrosine Kinase Inhibitor (TKI) respectively. For uncommon EGFR mutations, it is still unclear which EGFR TKI is most effective, since there are few dedicated prospective studies and Next Generation Sequencing (NGS) techniques trace an increasingly large and sometimes little-known population of EGFR mutations. Objective: To determine the economic impact associated to afatinib and osimertinib, a Budget Impact model considering a 3-year time horizon with two scenarios was developed: a first scenario, called AS IS, based on treatment with afatinib and osimertinib according to a distribution of market shares as emerged from clinical practice; a second suitable scenario, called TO BE, based on reviewed literature data, assuming for each year a 10%, 15% and 20% increase in afatinib use, respectively. Methods: Budget Impact analysis was conducted using a dynamic cohort model, in which the annual number of patients with NSCLC and uncommon mutations was equally distributed over 12 months. Progression-free survival (PFS) data for afatinib and osimertinib were extrapolated up to 36 months from published Kaplan Meier curves, and then the number of patients was estimated for each treatment. Results: The increase of 10% in afatinib use allowed a saving of drug acquisition costs for the Italian NHS, over the 3-year time horizon, of –€ 622,432. The univariate sensitivity analysis shows the market share of osimertinib to be the parameter significantly affecting the results achieved in the base case. Conclusions: The potential increase in the use of afatinib in patients with NSCLC and uncommon mutations leads to lower drug acquisition costs, lower Budget Impact and a saving of money for the Italian NHS.
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Kowalski L, Krusen NE. Lung Cancer Screening Policy in Alaska and Occupational Therapy. Am J Occup Ther 2021; 75:12496. [PMID: 34781340 DOI: 10.5014/ajot.2021.048231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings. What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.
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Affiliation(s)
- Lesleigh Kowalski
- Lesleigh Kowalski, PhD, MOT, OTR/L, ATP, is Research Scientist, Department of Family Medicine, University of Washington, Seattle; . At the time of the research, Kowalski was Doctoral Student, College of Health of Professions, Pacific University, Forest Grove, OR
| | - Nancy E Krusen
- Nancy E. Krusen, PhD, MA, OTR/L, is Program Director and Associate Professor, Division of Occupational Therapy Education, University of Nebraska Medical Center, Omaha
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Kalinke L, Thakrar R, Janes SM. The promises and challenges of early non-small cell lung cancer detection: patient perceptions, low-dose CT screening, bronchoscopy and biomarkers. Mol Oncol 2020; 15:2544-2564. [PMID: 33252175 PMCID: PMC8486568 DOI: 10.1002/1878-0261.12864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
Lung cancer survival statistics are sobering with survival ranking among the poorest of all cancers despite the addition of targeted therapies and immunotherapies. However, improvements in tools for early detection hold promise. The Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) trial recently corroborated the findings from the previous National Lung Screening Trial low‐dose Computerised Tomography (NLST) screening trial in reducing lung cancer mortality. Biomarker research and development is increasing at pace as the molecular life histories of lung cancers become further unravelled. Low‐dose CT screening (LDCT) is effective but targets only those at the highest risk and is burdensome on healthcare. An optimally designed CT screening programme at best will only detect a low proportion of overall lung cancers as only those at very high‐risk meet screening criteria. Biomarkers that help risk stratify suitable patients for LDCT screening, and those that assist in determining which LDCT detected nodules are likely to represent malignant disease are needed. Some biomarkers have been proposed as standalone lung cancer diagnosis tools. Bronchoscopy technology is improving, with better capacity to identify and obtain samples from early lung cancers. Clinicians need to be aware of each early lung cancer detection method’s inherent limitations. We anticipate that the future of early lung cancer diagnosis will involve a synergistic, multimodal approach, combining several early detection methods.
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Affiliation(s)
- Lukas Kalinke
- Lungs for Living Research Centre, University College London, UK
| | - Ricky Thakrar
- Lungs for Living Research Centre, University College London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, University College London, UK
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Lazzaro R, Patton B. Applying "Kennedyism" to lung cancer treatment: Let's take more nodes. JTCVS Tech 2020; 1:114-116. [PMID: 34317730 PMCID: PMC8288815 DOI: 10.1016/j.xjtc.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/28/2019] [Accepted: 11/17/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Richard Lazzaro
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY
| | - Byron Patton
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY
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Khakwani A, Harden S, Beckett P, Baldwin D, Navani N, West D, Hubbard R. Post-treatment survival difference between lobectomy and stereotactic ablative radiotherapy in stage I non-small cell lung cancer in England. Thorax 2019; 75:237-243. [PMID: 31879316 DOI: 10.1136/thoraxjnl-2018-212493] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Approximately 15%-20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curative intent treatment option for patients who are not selected for or do not choose surgery. The aim of this study is to compare survival at 90 days, 6 months, 1 year and 2 years for patients who received either lobectomy or SABR. METHODS We used data from the 2015 National Lung Cancer Audit database and linked with Hospital Episode Statistics and the radiotherapy dataset to identify patients with NSCLC stage IA-IB and performance status (PS) 0-2 who underwent surgery or SABR treatment. We assessed the likelihood of death at 90 days, 6 months, 1 year and 2 year after diagnosis and procedure date to observe survival between two patient groups. RESULTS We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening PS were associated with having SABR rather than surgery. Survival between the two treatment modalities was similar early on but by 1-year people who had surgery did better than those who had SABR (adjusted ORs 2.12, 95% CI 1.35 to 2.31). This difference persisted at 2 years and when the analysis was restricted to patients aged <80 years and with PS 0 or 1 and stage IA only. CONCLUSION Our analysis suggests that patients who have lobectomy have a better survival compared with SABR patients; however, we found considerable delays in patients receiving SABR which may contribute to poorer long-term outcomes with this treatment option. Reducing these delays should be a key focus in development and reorganisation of services.
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Affiliation(s)
- Aamir Khakwani
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
| | - Susan Harden
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Beckett
- Department of Respiratory Medicine, Derby Hospital NHS Foundation Trust, Derby, UK
| | - David Baldwin
- City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Neal Navani
- Lungs for Living Research Centre, University College London Hospital, London, UK
| | - Doug West
- Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Richard Hubbard
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
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Innos K, Oselin K, Laisaar T, Aareleid T. Patterns of survival and surgical treatment in lung cancer patients in Estonia by histologic type and stage, 1996-2016. Acta Oncol 2019; 58:1549-1556. [PMID: 31286812 DOI: 10.1080/0284186x.2019.1637539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Lung cancer (LC) remains the most frequent cause of cancer death worldwide. We aimed to examine long-term trends in LC survival in Estonia by age, gender, histologic type and stage, with specific focus on surgical treatment.Material and methods: Data on all incident cases of LC diagnosed from 1996 to 2016 were obtained from the Estonian Cancer Registry. Logistic regression was used to examine receipt of surgical treatment in localized LC. Relative survival ratios (RSR) were calculated, and excess hazard ratios (EHR) of death were estimated by stage with gender, age, histology and period of diagnosis as independent variables.Results: Among the total of 16,423 cases, squamous cell carcinoma remained the most common histologic type. The odds of receiving surgical treatment in localized LC increased significantly over time and were associated with age, gender and histologic type. Overall, the age-standardized 5-year RSR improved significantly from 10% in 1996-2002 to 16% in 2010-2016 (from 8% to 15% in men and from 15% to 20% in women). Larger survival gain was seen in younger patients, for non-small cell LC subtypes, and for surgically treated patients. For localized disease, the 5-year RSR increased by more than 20 percentage units, reaching 50% in men and 69% in women. For all stages, the adjusted EHR of death was significantly associated with age, histologic type and period of diagnosis.Conclusions: We observed a substantial improvement of relative survival, with considerable variations across patient groups. After adjustment for age, gender and histology, a significant survival increase over time was seen for all stages. The considerable survival gain observed for localized LC can largely be attributed to rapidly growing proportion of surgically treated patients. Further investigation of LC management practices, particularly the use of non-surgical treatment options is warranted.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Kersti Oselin
- Department of Chemotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre, Tallinn, Estonia
| | - Tanel Laisaar
- Department of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Pulmonology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tiiu Aareleid
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
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Peake MD, Navani N, Baldwin DR. The continuum of screening and early detection, awareness and faster diagnosis of lung cancer. Thorax 2018; 73:1097-1098. [PMID: 30097536 DOI: 10.1136/thoraxjnl-2018-212189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Michael D Peake
- Department of Respiratory Medicine, University of Leicester, Leicester, UK.,Centre for Cancer Outcomes, Cancer Collaborative, University College London Hospitals, London, UK.,National Cancer Registration and Analysis Service, Public Health England, London, UK.,Department of Thoracic Medicine, University College London Hospitals, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.,Department of Early Diagnosis and Health Professional Engagement, Cancer Research UK, London, UK
| | - David R Baldwin
- Department of Respiratory Medicine, University of Nottingham, Nottingham, UK
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