Lung Cancer Specialists Research Articles

Approach to biomarker testing: perspectives from various specialties.

Despite its importance for patient outcomes, biomarker testing for lung cancer is not uniformly integrated into the Canadian health care system. To better understand current practice patterns for lung cancer biomarker testing, we assessed physician perspectives by specialty and region. A national survey of Canadian lung cancer specialists was conducted to understand their perspectives on biomarker testing in lung cancer. The 11-item survey assessed the current practice and challenges of testing. The survey was sent to 375 specialists. The overall response rate for the survey was 36%. Nearly all specialists reported that knowing tumour genotyping results affects patient outcome and influences the treatment decision. Medical oncologists most commonly initiated molecular testing; however, most respondents suggested a shared model involving medical oncologists and pathologists. More than half of all responding specialists had the perception that fewer than 25% of test results are available for first-line treatment decisions. Identified barriers to routine testing for all lung cancer patients included cost, lack of funding, tissue availability, and sample quality. There was clear agreement that biomarker testing is important in determining appropriate treatment for patients. There is a need for general consensus on who should initiate molecular testing. Clear clinical guidance for pathologists has to be established for molecular testing, including defining the population to be tested, the timing of testing, and the tests to be performed. Testing could be facilitated by including more information on diagnostic sample requisitions, such as clinical suspicion of primary lung cancer, cancer history, and other samples already collected.

Older patients miss out in access to specialist lung disease services.

PEOPLE OVER the age of 75 are less likely than their younger counterparts to receive an assessment from a lung cancer specialist nurse, despite national guidelines calling for direct, personal access for every person diagnosed with the disease.

Variation in lung cancer resources and workload: results from the first national lung cancer organisational audit

We report the findings of the first national lung cancer organisational audit. The results demonstrate marked variation in service provision and workload of some lung cancer specialists. For example, over...

Attitudes and referral patterns of lung cancer specialists in Europe to Specialized Palliative Care (SPC) and the practice of Early Palliative Care (EPC).

PurposeTo examine availability of Palliative Care (PC) services and referral patterns of European Lung cancer specialists to PC.MethodsAll members of the EORTC Lung Cancer Group (LCG) were asked via email to participate in an on-line survey.Results50 out of 170 (29.4%) replied: 24 medical oncologists, 14 radiation/clinical oncologists, 11 pulmonologists and 1 thoracic surgeon. All but two of respondents (96%) had access to at least one component of PC services. In terms of referral of patients to PC almost 75% of respondents would refer most of their patients when there were no treatment options or at the end of life, while only 22% would refer patients at earlier stages of disease. Barriers for referral to PC were negative attitudes of patients to PC (26%), lack of availability of PC services (20%), lack of expertise of PC physicians(18%), the belief that referral to PC signifies abandoning patients (8%), and that PC specialists discourage active oncological therapy (8%). Whilst most of the respondents expressed positive attitudes, 12-22% had overtly negative attitudes towards PC. Seventy-eight (78%) of respondents expressed an interest to participate in a trial of early PC (EPC).ConclusionDespite good availability of SPC services at institutions of members of the EORTC LCG, and most respondents expressing positive attitudes towards PC, their practice involved referral of patients to PC late in the disease trajectory, hence Lung Cancer specialists in Europe have not adopted the practice of EPC concurrent with active oncological care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-684X-13-59) contains supplementary material, which is available to authorized users.

S70 Results From The First National Lung Cancer Organisational Audit

Background National Lung Cancer Audit reports consistently demonstrate variation in diagnostic pathways, treatment rates and outcomes which are not wholly explained by case-mix. One possible explanation for this variation is different access to diagnostics and treatment specialists, however little is known about the provision of these services across England and Wales lung cancer services. Methods An electronic survey was sent to all lung cancer lead clinicians in England and Wales in January 2014. The survey included seven questions for all MDTs on service provision, diagnostic services, staging services, and lung cancer treatment. There were a further 3 questions for treatment centres. Two reminders were sent and the survey closed in May 2014. Results 128 records were submitted from 176 trusts. After removal of duplicate and empty records 101 were available for analysis. Mean (range) average number of patients discussed per MDT meeting is 26 (5–88) and 29% Trusts have a separate diagnostic meeting. There is considerable variation in the mean (range) number of whole time equivalent (wte) on site lung cancer specialists e.g. thoracic pathologists 1.4 (0–10), lung CNS 2.0 (0.5–10) and respiratory physicians 3.9 (0–20). Most diagnostic and staging procedures are available either on or off site, although medical thoracoscopy is not available at all to 14% Trusts. Chemotherapy, radiotherapy and surgery are available on site in 89%, 33% and 18% of Trusts, respectively. VAT lobectomy, stereotactic radiotherapy and radiofrequency ablation are not available at all to 6%, 5% and 10% of Trusts, respectively. Centres performing thoracic surgery report mean (range) wte number of surgeons at 1.5 (0–6) and thoracic HDU beds at 4 (0–24). Acute oncology services are available to 92% chemotherapy treatment centres and 96% radiotherapy centres. Conclusion The data provide a moderately representative snapshot of diagnostic and treatment services available for lung cancer patients in England and Wales. There is significant variation in the number of specialists available and some patients do not have access to key treatment modalities e.g. VAT lobectomy. Further work is required to determine how this relates to patient experience and outcomes. All Trusts are encouraged to submit validated data for the next round of organisational audit.

Performance of a low-dose computed tomography (LDCT) lung cancer screening program: Findings from a registry study.

304 Background: Many centers are establishing LDCT lung cancer screening programs after the 2013 grade B recommendation from the United States Preventive Services Task Force (USPSTF). Uncertainty remains regarding the extent to which new programs will adhere to recommended selection criteria, as well as screening program performance. We analyzed adherence to selection criteria, rate of positive screens, and prevalence of incidental findings in a single-center LDCT screening registry study. Methods: We established a prospective, longitudinal registry study of patients undergoing LDCT screening at the Seattle Cancer Care Alliance. Baseline data include socio-demographic characteristics and eligibility for LDCT screening. We conduct chart reviews at 6 and 12 months to determine screening results (based on NLST definitions); lung cancer diagnosis; and incidental findings. Results: From August 2012 to April 2014, 62 out of 105 (59%) screened patients enrolled in the registry. Mean age is 62 years; 38 (61%) are male; 52 (84%) are white; mean household income is $97,363; 31 (50%) are current smokers; and 39 (63%) have a smoking history ≥ 30 pack-years. A total of 28 (45%), 31 (50%), and 31 (50%) of patients were eligible for screening based on criteria used in the NLST or recommended by the NCCN or USPSTF guidelines, respectively. Sixteen patients (26%) were not eligible for screening based on any of these criteria. For fourteen (88%) of these patients, LDCT screening was ordered by a primary care provider as opposed to a lung cancer specialist. Initial screening results were positive in 7 (13%) patients, with 1 patient diagnosed with lung cancer. At least one incidental finding was reported in 40 (74%) patients, including cardiac and pulmonary abnormalities in 28 (70%) and 25 (63%) patients. Conclusions: About one quarter of patients undergoing LDCT screening do not meet recommended criteria, with primary care providers most commonly ordering the LDCT screen for these patients. Primary care provider education may improve adherence to screening guidelines. Incidental findings were more frequently reported than in the NLST; their impact on healthcare outcomes and costs deserves further investigation.

Emerging Science and Therapies in Non-small-Cell Lung Cancer: Targeting the MET Pathway

During this enduring, learner-driven, interactive CME webseries, lung cancer specialists will address the science and targeted therapies for the MET pathway in non-small cell lung cancer. Over the past decade, research has evolved in the science of identifying targeted biological changes in DNA and individual cancer cells. Along with the advanced understanding of lung cancer mutations, has come the development of specific targeted therapies that improve patient outcomes. The first step in treating a patient with lung cancer is proper diagnosis and staging, applying to the principles of personalize medicine. Our current understanding of lung cancer is that of a collection of diseases individualized through specific mutations. This CME activity reviews the role of the pulmonologist and pathologist in proper tissue acquisition and analysis. This new era of personalized medicine and clinical research advances has changed the way clinicians evaluate and treat patients with lung cancer. The data on lung cancer cell mutations and newer targeted therapies have improved the progression free survival and quality of life of lung cancer patients. This CME activity is designed to present a practical overview of recent evidenced based data of MET targeted therapies for patients with lung cancer. As research continues to evolve, we continue to advance our understanding in the science of lung cancers involving the MET pathway. Evidenced based data supporting newer targeted therapeutics provides insight on applying treatment for optimal outcomes. This CME activity will focus on the individualized treatment strategies using practical decision making for patients with MET expression. This activity has been designed to meet the educational needs of medical oncologists, pathologists, radiation oncologists, surgeons, pulmonologists, internists, and other healthcare clinicians responsible for the care of patients with lung cancer. Online access:http://www.elseviercme.com/516/.

Quality Indicators for the Evaluation of Patients With Lung Cancer

Ideally, quality indicators are developed with the input of professional groups involved in the care of patients. This project, led by the Thoracic Oncology Network and Quality Improvement Committee of the American College of Chest Physicians (CHEST), had the goal of developing quality indicators related to the evaluation and staging of patients with lung cancer. Evidence-based guidelines were used to generate a list of process-of-care quality indicators, and project members revised the content and wording of this list. A survey of the Steering Committee of the Thoracic Oncology Network was performed to rate the validity, feasibility, and relevance of the indicators. Predefined thresholds were used to select indicators from the list. This process was repeated for the selected indicators through a survey available to all members of the Thoracic Oncology Network. Three academic medical centers determined if the surviving indicators were feasible and relevant within their practices. Eighteen quality indicators were drafted. Eleven survived the first round of voting, and seven survived the second round of voting. One was related to tissue acquisition for molecular testing, four were related to staging and stage documentation, one was related to smoking cessation counseling, and one was related to documentation of a performance status measure. The indicators were feasible and relevant within the practices assessed. We have defined seven process-of-care quality indicators related to the evaluation and staging of patients with lung cancer, which are felt to be valid, feasible, and relevant by lung cancer specialists.

Radon and lung cancer: assessing and mitigating the risk.

Radon is a naturally occurring radioactive gas. Its progenies emit alpha particles capable of causing tissue damage. Radon exposure is estimated to be the second most common cause of lung cancer in the United States. Management of patients with a history of radon exposure should involve a lung cancer specialist.

Targeted therapy in lung cancer: survival, quality of life improved for some patients.

Targeted therapy in lung cancer: survival, quality of life improved for some patients.

Stress, satisfaction and burnout amongst Australian and New Zealand radiation oncologists.

The aim of this study was to determine the self-reported prevalence of stress, job satisfaction and burnout among radiation oncologists in Australia and New Zealand. A secondary aim was to determine the association between stress and satisfaction parameters with burnout. An anonymous online survey was distributed to all radiation oncologists listed on Royal Australian and New Zealand College of Radiologists membership database. There were 37 Likert scale questions on stress, 17 Likert scale questions on job satisfaction and burnout assessed by the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A principal component analysis was done for stress and satisfaction to identify specific areas. Independent samples t-tests and analysis of variances were done. There were 220 responses out of 348 eligible respondents (63.2% response rate).For stress, a principal component analysis identified five areas: delivery demands, demands on time, continuing professional development (CPD), value and security, and interpersonal/teaching demands. Specialist radiation oncologists were more stressed by value and security than generalists (P < 0.01). Lung cancer specialists had higher levels of stress associated with delivery demands, demands on time and CPD compared with others (P = 0.01). Those over 60 years were less stressed by delivery demands (P = 0.02), demands on time (P = 0.01) and CPD (P = 0.01) than their younger colleagues. Four satisfaction factors were identified in the principal component analysis: resources/remuneration, status/security, delivery of services and professional activities. [Correction added on 15 August 2014, after first online publication: stress/security was replaced with status/security.] Males and Australian radiation oncologists were more satisfied with professional activities (P = 0.02). Brachytherapy specialists were more satisfied with status/security (P = 0.01) while those interested in urology were more satisfied with resources/renumeration (P = 0.01) and professional activities (P = 0.01). The burnout results revealed at least 48.5% of respondents scoring highly in at least one of the three measures of burnout (emotional exhaustion, depersonalisation and personal accomplishment) while 37.5% scoring highly in the emotional exhaustion and depersonalisation subscales. Public sector radiation oncologists had higher levels of emotional exhaustion and lower levels of personal accomplishment than their private sector counterparts, while those interested in lung cancer had higher levels of emotional exhaustion. Multiple regression analysis revealed that the stress subscale demands on time had a significant effect on emotional exhaustion. Higher CPD stress and interpersonal/teaching demands increased the feeling of depersonalisation, while satisfaction with delivery of services was associated with lower levels of depersonalisation and higher levels of personal accomplishment. This first study of stress, satisfaction and burnout among radiation oncologists in Australia and New Zealand had a reasonable response rate and identified specific areas of stress and satisfaction. Nearly half of the respondents scored highly in one burnout subscale. Some of the stress and satisfaction subscales correlated with certain aspects of burnout. Further research will be undertaken to refine the stress and satisfaction parameters and address burnout interventions.

Lack of specialist lung cancer care.

Three quarters of UK lung cancer patients do not have regular access to 'vital' clinical nurse specialists, a new report reveals.

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1–10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.

S106 “Reasons to be cheerful”–data from year 8 of the national lung cancer audit

IntroductionThe National Lung Cancer Audit, now in its 8th year, is run jointly by the Royal College of Physicians and The Information Centre for health and social care, and is...

P73 The creation of a simulated pan-deanery medical thoracoscopy and indwelling pleural catheter course

IntroductionMedical thoracoscopy (MT) and indwelling pleural catheter (IPC) insertion are becoming increasingly utilised for the purposes of diagnostic and therapeutic intervention in pleural disease. We are at the cusp of...

Website Visitors Asking Questions Online to Lung Cancer Specialists: What Do They Want To Know?

BackgroundIn 2003 the Dutch Lung Cancer Information Centre (Longkanker Informatie Centrum) launched a website containing information on lung cancer accessible to anyone.ObjectiveOur study aim was to inventorize the information needs of the visitors of this website by analyzing the questions they asked the lung cancer specialists in the websites interactive section “Ask the Physician”.MethodsThe first 2000 questions posted up until May 2006 have been classified by visitors’ wish, type of required information, identity, gender, and phase during treatment course.ResultsOur results show that 1893 (1158/1893, 61%) of the questions were asked by a loved one/caregiver and (239/1893 13%) by patients. 1 out of 3 questions was asked by a daughter/grand-daughter. Most questions concerned specific information on lung cancer and lung cancer course (817/1893, 43%). The most inquired specific information topics were therapy side effects, diagnostics, general information on lung cancer, and regular therapy. Furthermore, questioners wanted to verify their own doctor’s information (122/1893, 6%), a diagnosis (267/1893, 14%), and a prognosis (204/1893, 11%).ConclusionsLung cancer patients and their caregivers asked the most questions in the interactive website section. The most frequently requested information was more detailed information. These include specific information on lung cancer (regular therapy, diagnostics, and disease symptoms), verification of what the doctor has said, diagnosis, and prognosis. Most of the requested information could have been obtained from treating specialists, indicating that current information supply to lung cancer patients and their caregivers may not be matching their needs sufficiently. The further implementation of an online dialogue with lung cancer specialists might be a solution.

115 Surgical lung cancer specialist nurse in accordance with NICE standard

115 Surgical lung cancer specialist nurse in accordance with NICE standard

137 Supporting lung cancer specialist nurses. Providing accredited training to Roy Castle affiliated group facilitators

137 Supporting lung cancer specialist nurses. Providing accredited training to Roy Castle affiliated group facilitators

P67 Lung Nodule Follow-Up Survey of London and East of England Hospitals: What Are We Actually Doing?

BackgroundThe widespread use of computed tomography (CT), to investigate both lung and non-lung pathology has led to the finding of increasing numbers of incidental pulmonary nodules. The BTS is currently...

105IN - Lung Cancer: The European Thoracic Oncology Platform

ABSTRACT The European Thoracic Oncology Platform (ETOP) is a foundation with the purpose to promote exchange and research in the field of thoracic malignancies. It was founded in 2009 and continuous to enlarged its membership to now comprise more than 40 members, including groups and institutions from most parts of Europe, as well as one large cancer center in the USA and China, respectively (www.etop-eu.org). ETOP promotes exchange of information and research. This is done be an active web-site, a yearly ETOP meeting for associated members and their investigators, and by a residential workshop aimed at fostering the research activity of younger investigators. Lungscape is a large translational research project designed by ETOP. It aims to coordinating the research of a group of lung cancer specialists working in translational research across Europe. This initiative has the potential to facilitate more rapid translation of biomarker knowledge to the clinic. Lungscape is evolving in step-wise fashion, starting with a retrospective analysis of up to 2400 completely resected NSCLC from 16 institutions. The fundamental approach of Lungscape was to build a decentralized iBiobank of samples from lung cancer patients with annotated clinical and pathological data and at least three years of documented follow-up. The virtual nature of iBiobank and the introduction of standardized biomolecular assessments - in which samples are tested using identical protocols across local laboratories- removes the need of transferring samples to a central location for evaluation. ETOP has also initiated two clinical trials with biomarker components. BELIEF is phase II trial with erlotinib and bevacizumab for patients with non-squamous cell lung cancer and activating EGFR mutation stratified by the presence of T790M mutation as determined centrally by a very sensitive methodology. This is done on preclinical evidence suggestion synergy between EGFR TKI and antiangiogenetic therapy for tumors in case of activating mutation and the presence of T790M. The EMPHASIS lung is a phase III trial comparing erlotinib and docetaxel in second line for squamous cell lung cancer. The study will allow determining the predictive role of a serum proteomic classifier called VeriStrat for a beneficial effect of erlotinib. Other trials are in preparation. Disclosure The author has declared no conflicts of interest.