homework

January 2017 Abstracts S309

OA17.02

Potential Health and Economic Consequences of Organized vs Opportunistic Lung Cancer Screening in Canada

William Evans,1 Cindy Gauvreau,2 Saima Memon,2

John Goffin,3 Jason Lacombe,2 Michael Wolfson,4

Natalie Fitzgerald,2 Anthony Miller5 1Cancer Care Ontario, Toronto/ON/Canada, 2Canadian Partnership Against Cancer, Toronto/ON/Canada, 3Oncology, Juravinski Cancer Centre, Hamilton/ON/Canada, 4Populemics, University of Ottawa, Ottawa/ON/Canada, 5Public Health, University of Toronto, Toronto/ON/ Canada

Background: Annual LDCT screening for individuals 55- 74 yrs with >30 pack-year smoking history is supported by evidence from the NLST but has led to questions of implementation. Compared to organized screening (ORG), opportunistic screening (OPP) may utilize broader entry criteria and not include smoking cessation.

Methods: Health and economic impacts of ORG using NLST entry criteria were modelled using population microsimulation (OncSim e formerly Canadian Risk Management Model v 2.3) and compared to OPP sce- narios. We modeled ORG at a participation rate of 30 and 60%, with and without smoking cessation, compared to various plausible OPP scenarios: younger individuals (40-74 yrs); lesser smoking histories (10 or 20 pack- yrs). Outcomes projected to 20 years included incidence, mortality, number of scans, invasive diagnostics for false positives, and screening and treatment costs. A lifetime horizon and 3% discounting were used to estimate the incremental cost-effectiveness ratio (ICER) from a health system perspective. All costs are in 2016 CAD.

Results: A large number of outputs can be presented. At a participation rate of 30%, average annual incremental incident cases of lung cancer with OPP for 40-74 yr-olds with 10 pack-yr histories are higher by 254 over ORG without cessation, and there would be an average 135 fewer deaths annually. However, the annual number of CT scans would increase by 433,000 on average and diagnostic tests for false positive results would increase by 1540. Average annual costs would increase by $141 M compared with ORG without cessation, resulting in an ICER of $133,000/QALY. OPP with 40-74 yr-olds having 20 and 30 pk-yr histories result in $92,147 and 74,978/ QALY respectively. In all cases of OPP compared to ORG with cessation there are net losses of QALY. Notably, ORG with smoking cessation compared to ORG without yields an ICER of $2800/QALY.

Conclusion: OPP screening results in more incident cases and fewer deaths but more cost from over-diag- nosis and false positives. In Canada, an annual screening program with strict adherence to NLST entry criteria could be highly cost-effective. Jurisdictions will have to weigh the benefits and risks of LDCT scanning beyond the currently available evidence.

Keywords: screening, organized, opportunistic, cost

OA17.03

Insurance Type Influences Stage, Treatment, and Survival in Asian American Lung Cancer Patients

Apichat Tantraworasin,1 Emanuela Taioli,2

Bian Liu,2 Andrew Kaufman,1 Raja Flores1 1Thoracic Surgery, ICAHN Medical School at Mount Sinai, New York/ NY/United States of America, 2Population Health Science and Policy, ICAHN School of Medicine at Mount Sinai, New York/United States of America

Background: Effect of insurance type on lung cancer diagnosis, treatment and survival is still under debate in Asian patients living in United States.

Methods: A total of 447,167 patients (18 to 113 years), diagnosed with lung cancer between 2004 and 2013 in the Surveillance, Epidemiology, and End Results data- base were analyzed. Patient demographics and clinical characteristics were compared between Asian and Non- Asian patients. In Asian patients, patient demographics and characteristics were compared among insurance types. Multivariable logistic regression analysis was performed to identify the effect of insurance types on stage at diagnosis and treatment modalities. Multivar- iable cox’s regression analysis was performed to iden- tify the effect of insurance type on cancer-specific death.

Results: Asian were significantly more frequently males (56.7% vs. 53.1%), married (62.2% vs. 50.2%), with Medicaid (17.4% vs. 8.7%), living in rural area (93.6% vs. 86.9%), in a low income county (26.3% vs. 13.4%), and stage 4 at time of diagnosis (51.1% vs. 48.0%) than non- Asian patients (all p-value < 0.001). Among 26,884 Asian lung cancer patients, uninsured were significant younger (61.1±10.8 years) than non-Medicaid (69.1±11.9 years) and Medicaid (70.7±11.7 years), p <0.001, more likely single (18.9 % vs. 8.8% vs. 13.0%); living in a high income county (41.8% vs. 30.5% vs. 38.6%); more likely to be stage IV (63.7% vs. 50.0% vs. 51.2%); and not undergo surgery (86.2% vs. 75.4% vs. 82.6%), [all p-value < 0.001). Localized disease was more frequent in non- Medicaid (21.2%) and Medicaid (17.3%) compared to

S310 Journal of Thoracic Oncology Vol. 12 No. 1S

uninsured (9.0), (p < 0.001). At multivariable analyses, insurance type was not associated with cancer-directed surgery and radiotherapy. Insurance was significantly associated with cancer-specific death (uninsured HR 1.37 95%CI 1.07-1.75; non-Medicaid HR 1.17 95% CI 1.07- 1.28 vs Medicaid).

Conclusion: Insurance type affects stage at diagnosis and cancer-specific death but not surgical treatment and radiotherapy in Asian lung cancer patients.

Keywords: Disparities, race, cancer-specific death, insurance

OA17.05

Survival in a Cohort of Patients with Lung Cancer: The Role of Age and Gender on Prognosis

Juliana Franceschini, Sérgio Jamnik, Ilka Santoro Universidade Federal de São Paulo, São Paulo/Brazil

<55 165

Male n(%) 87 (53) Smoke n(%) 136 (82) Male 78 (90) Female 58 (74) Histological type n(%) Adenocarcinoma 92 (56) Squamous Cell Carcinoma 52 (32) Staging n(%) IA/IIIA 34 (21) IIIB/IV 131 (79) Deaths n (%) 83 (50) Follow-up (months) Median[IIQ] 4.9 [1.3-13.2]

*Chi-square test; † Kruskal-Wallis (Duncan test); ‡oneway ANOVA (Bon

Background: Lung cancer has a high incidence in Brazil; approximately thirty-four thousand new cases are diagnosed each year. In Brazil, as in other coun- tries, the majority of patients diagnosed with lung cancer are elderly. There are few studies that evaluate demographic and clinical characteristics, disease staging, treatment modalities and survival in young patients, mostly carried out in developed countries. This study aimed to describe these aspects in patients with non-small cell lung cancer (NSCLC) according to age.

Methods: Retrospective cohort consisted of patients diagnosed with NSCLC followed in a referral hospital in São Paulo. During the monitoring the survival time was evaluated. Survival functions were calculated using the method of Kaplan-Meier. The survival stratified by age was also obtained, according to distribution of percentages (less than 55; between 55 and 72 years; older than 72 years). Differences between survival curves were determined using the log-rank test.

Results: From January 2000 to July 2015 790 patients were followed, 165 aged less than 55 years, 423 between 55 and 72 years and 202 older than 72 years. Higher incidence of adenocarcinoma was seen at the groups up to 72 years. 575 (73%) patients with advanced disease (IIIB-IV stages) were observed. The median five-year survival was 12 months [46-4]. The survival of patients in different age groups was not different.

Conclusion: In the age group of younger patients (<55) women predominated, histological type adenocarcinoma was more frequent, and there were more patients with advanced stage at the diagnosis and a higher percentage of smokers in both genders.

Keywords: lung cancer, age, survival

�55<72 423 �72 202 p 279 (66) 127 (63) 0.012* 363 (86) 165 (82) 0.34* 263 (94) 121 (95) 0.21* 100 (69) 44 (59) 0.10*

0.13* 216 (51) 91 (45) 170 (40) 91 (45)

0.057* 127 (30) 52 (26) 294 (70) 150 (74) 232 (55) 105 (52) 0.56* 6.5 [2.0-16.3] 4.4 [1.4-12.9] 0.07†

ferroni test).