ABSTRACT
Background: Patients with non-small cell lung cancer (NSCLC) treated with adjuvant vinorelbine-platinum chemotherapy experience neutropenia, which may lead to early termination of treatment. However, evidence suggests that survival is superior in patients who complete four cycles of chemotherapy [1]. Granulocyte colony stimulating factor (GCSF) prophylaxis is used to prevent neutropenia. During the COVID pandemic, the threshold for initiating prophylaxis was lowered to reduce need for hospital attendance with the concomitant risk of hospital-acquired infection [2]. We evaluated whether GCSF prophylaxis supported completion of chemotherapy in patients treated at St Bartholomew's Hospital. Method(s): Data was retrospectively collected on the 112 patients with NSCLC who received adjuvant vinorelbine-platinum chemotherapy (total 349 cycles) in the period Jan 2017- Jul 2022. GCSF prophylaxis was prescribed at physician discretion. chi2 tests were carried out using SPSS 28. Result(s): A significantly higher proportion of patients who received GCSF prophylaxis completed four cycles of chemotherapy (chi2=5.120, p=0.024). These patients also experienced a lower incidence of grade 3 or 4 neutropenia (chi2=6.801, p=0.009). Over 5 years, 2/112 (1.75%) patients died, both from neutropenic sepsis;neither of these patients received prophylactic GCSF. GCSF prophylaxis was not associated with increase in the incidence of thromboembolic events (chi2=1.462, p=0.442). Conclusion(s): GCSF is safe and effective as primary prophylaxis in NSCLC patients receiving adjuvant chemotherapy. Use of GCSF will reduce proportion of post-operative patients considered too high risk for chemotherapy due to concerns about neutropenia. Disclosure: No significant relationships. [Figure presented]Copyright © 2023 Elsevier B.V.
ABSTRACT
Introduction: Extensive stage small cell lung cancer (ES-SCLC) is the most aggressive form of lung cancer, and delays in treatment result in worse outcomes. The National Lung Cancer Audit1 guidelines advise 70% of patients should receive systemic treatment and 80% within 14 days of pathological diagnosis. We aimed to assess compliance with these recommendations and improve the treatment pathway for patients with ES-SCLC in East London. Method(s): To establish baseline metrics, we reviewed compliance with these guidelines in all patients diagnosed with ES-SCLC in 2019 (pre-COVID pandemic). Two interventions were made: i) admission of all newly diagnosed patients for urgent chemotherapy to improve time to treatment and ii) all newly diagnosed ES-SCLC patients across our network of five hospitals were requested to be reviewed by or transferred under a lung oncologist to improve treatment rates. We re-evaluated data from all ES-SCLC patients diagnosed in 2022 using the same pre-intervention criteria. Result(s): 31 patients in 2019 and 17 patients in 2022 were included. There was no significant difference in baseline characteristics including (median) age (68 vs 70, p=0.64), co-morbidities (1 vs 1, p=0.12), and performance status (1 vs 1, p=0.86) between cohorts. There was a significant decrease in the median [range] time to treatment (13 [4-80] days vs 4 [1-31] days, p=0.03] and an increase in the proportion of patients reviewed by a lung oncologist (74% to 100%, p=0.04). There was also an increase in the proportion of patients receiving treatment (61% vs 77%). [Figure presented] Conclusion(s): Our data suggest that these interventions may improve the proportion of patients receiving treatment and the time to treatment. Larger local audits and correlation with national data is required to evaluate the impact these interventions have on outcomes. Reference: [1] RCP National Lung Cancer Audit Annual Report. 2022. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.