P40.09 Using Real World Data to Identify a Patient Cohort Who Require Prehabilitation to Improve Treatment Rates for Stage 3 NSCLC

Abstract

Patients with stage 3 Non Small Cell lung Cancer (NSCLC) are a heterogeneous group. Recent National Lung Cancer Audit (NLCA) indicates a third of patients (36%) received no active treatment. We audited the treatment received by all stage III NSCLC patients treated between April 2014 and April 2017 at the Edinburgh Cancer Centre. Using this data, we hope to delineate patterns in our selection of treatment based on a patient’s performance status and co-morbidities, to better understand which patient groups may be more likely to receive sub-optimal treatment. 374 patients were identified via local cancer registry. Patients were then categorised by treatment modality, ECOG performance status (PS) and Charlson morbidity score (CMS). Radical treatment was defined as chemoradiotherapy, radical radiotherapy or surgery. 374 patients were identified: 190 males (50.8%) and 184 females (49.2%). 222 patients (59.36%) were aged ≥70yrs, with a median age of 71yrs (range 42-93yrs). Median follow-up period was 398 days (range: 0-2445 days). 105 patients (28.07%) had a CMS of ≥1. 118 patients (31.55%) had an adenocarcinoma tumour type, 117 patients (31.28%) had squamous histology, 35 patients (9.36%) had other NSCLC histology and 4 patients (1.07%) had non-lung cancer histology. Histology was unavailable for 100 patients (26.74%). Radical treatment was given to 200 patients - surgery (24 patients, 12%), chemoradiotherapy (99 patients, 49.5%) and radical radiotherapy (77 patients, 38.5%). Of those with a PS 0 (64 patients): 47 (73.44%) received radical treatment; 12 (18.75%) received non-radical treatment, and 5 (7.81%) did not receive any treatment. Of those with PS 1 (178 patients): 115 (64.61%) received radical treatment; 27 (15.17%) received non-radical treatment, and 36 (20.22%) did not receive any treatment. Of those with a PS 2 (112 patients): 37 (33.04%) received radical treatment; 29 (25.89%) received non-radical treatment, and 46 (41.07%) did not receive any treatment. 20 patients did not have a clear documentation of their PS – 18 of these did not receive any treatment. Of those with CMS 0 (269 patients): 152 (56.51%) received radical treatment; 56 (20.82%) received non-radical treatment, and 61 (22.68%) did not receive any treatment. Of those with CMS 1 (61 patients): 34 (55.74%) received radical treatment; 6 (9.84%) received non-radical treatment, and 21 (34.43%) did not receive any treatment. Of those with a CMS ≥2 (44 patients): 14 (31.82%) received radical treatment; 7 (15.91%) received non-radical treatment, and 23 (52.27%) did not receive any treatment. Those with a better PS and CMS were more likely to receive treatment with radical intent. Those with a higher CMS were far more likely to receive no treatment or non-radical treatment. These patients may benefit from prehabilitation prior to treatment, to allow provision of life prolonging therapy to a greater cohort.