Christie Pratt

Lung cancer screening, version 3.2018

Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.

Lung Cancer Patients’ Decisions About Clinical Trials and the Theory of Planned Behavior

The theory of planned behavior explores the relationship between behavior, beliefs, attitudes, and intentions presupposing that behavioral intention is influenced by a person’s attitude about the behavior and beliefs about whether individuals, who are important to them, approve or disapprove of the behavior (subjective norm). An added dimension to the theory is the idea of perceived behavioral control, or the belief that one has control over performing the behavior. The theory of planned behavior suggests that people may make greater efforts to perform a behavior if they feel they have a high level of control over it. In this examination of data, we explored the application of the theory of planned behavior to patient’s decisions about participating in a clinic trial. Twelve respondents in this study had previously participated in a clinical trial for lung cancer and nine respondents had declined a clinical trial for lung cancer. The data were analyzed with regard to the four constructs associated with the theory of planned behavior: behavioral intention, attitude, subjective norm, and perceived behavioral control. Results indicate that the theory of planned behavior may be a useful tool to examine psychosocial needs in relation to behavioral intention of clinical trial participation.

Healthcare providers’ knowledge and attitudes about rapid tissue donation (RTD): phase one of establishing a rapid tissue donation programme in thoracic oncology

In preparation for the development of a rapid tissue donation (RTD) programme, we surveyed healthcare providers (HCPs) in our institution about knowledge and attitudes related to RTD with lung cancer patients. A 31-item web based survey was developed collecting data on demographics, knowledge and attitudes about RTD. The survey contained three items measuring participants’ knowledge about RTD, five items assessing attitudes towards RTD recruitment and six items assessing HCPs’ level of agreement with factors influencing decisions to discuss RTD. Response options were presented on a 5-point Likert scale. Ninety-one HCPs participated in the study. 66% indicated they had never heard of RTD prior to the survey, 78% rated knowledge of RTD as none or limited and 95.6% reported not having ethical or religious concerns about discussing RTD with patients. The majority were either not comfortable (17.8%) or not sure if they felt comfortable discussing RTD with cancer patients (42.2%). 56.1% indicated their knowledge of RTD would play an integral role in their decision to discuss RTD with patients. 71.4% reported concerns with RTD discussion and the emotional state of the patient. Physicians and nurses play an important role in initiating conversations about recruitment and donation to research that can ultimately influence uptake. Increasing HCP knowledge about RTD is a necessary step towards building an RTD programme. Our study provides important information about characteristics associated with low levels of knowledge and practice related to RTD where additional education and training may be warranted.

P2.09-17 A Call to Action: Rapid Collection of Post-Mortem Lung Cancer Tissue in the Community to Enable Lung Cancer Research

panel is a 31-gene NGS multiplex assay that synchronously detects multiple oncogene fusion transcripts from formalin-fixed paraffinembedded (FFPE) tissue derived RNA (Figure 1). Method: QIAseq analysis was undertaken in 33 samples (31 NSCLC samples, 2 commercial controls). 12/31 NSCLC samples were positive controls with a known fusion genotype identified by Quantide X NGS or FISH +/RTPCR. The remaining 19/31 fusion negative NSCLC controls included 6 samples with EGFR/KRAS/NRAS mutations. Analysis required a minimum 2x 5u Î M thick FFPE scrolls with >30% neoplastic cell content. Manual RNA extraction was undertaken in all samples except n1⁄46 (ExScale automation extraction). NGS fusion breakpoints, crossing and spanning reads were calculated in QIAseq fusion-detected samples. An additional validation cohort of 40 NSCLC samples, including 20 with unknown fusion status will optimise QIAseq thresholds for fusion detection. Result: 48 QIAseq sequencing experiments was undertaken in 33 samples with 2 sequencing runs in 12 samples. QIAseq analysis detected a corresponding NGS fusion breakpoint in 14/14 (100%) positive controls including EML4-ALK (n1⁄48), CLTC-ALK (n1⁄41), CD74ROS1 (n1⁄43), CCDC6-RET (n1⁄41) and 5-fusion control (n1⁄41). QIAseq analysis was negative in 17/19 (89.4%) negative controls samples including all KRAS (n1⁄44), NRAS (n1⁄41) and EGFR (n1⁄41) mutation samples. QIAseq detected novel fusion gene CD74 Exon 6-CAMK2A Exon 2 in n1⁄41 sample subsequently confirmed on Sanger sequencing. Two separate runs detected TPM3 Exon 8-S100A7A Exon 2 fusion in n1⁄41 sample not identified with Sanger sequencing. Both fusions have uncertain clinical significance. Validation cohort results will be presented. Conclusion: QIAseq detects NSCLC oncogenic fusions with high sensitivity and specificity. Future applications include optimising use of small biopsy specimens for synchronous gene rearrangement screening and identification of novel gene fusion targets.

Patient, Caregiver and Physician Perspectives on Participating in a Thoracic Rapid Tissue Donation Program

OBJECTIVE The collection of posthumous tissue from advanced stage lung cancer patients is beneficial to medical science. Recruiting living patients to a Rapid Tissue Donation Program (RTD) poses several psychosocial challenges and little is known about perceptions of joining this type of program. This study qualitatively examined perceptions of advanced stage lung cancer patients (n=14) participating in a lung cancer RTD program, their NoK (n=11), and physicians (n=6) at the Thoracic Oncology Clinic at H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida USA. METHODS Semi-structured interviews were conducted with participants and interview transcripts were analyzed using the constant comparison method. RESULTS Majority of patients joined to give back to research, discussed participation with family members, and desired for family to receive information about the use of the tissue after their death. All participating NoK were supportive of their family members decision. Physicians described the program as running smoothly, but provided suggestions for process improvements. CONCLUSION Participants joined with intention to give back to research community and families were supportive of loved ones participation in RTD. Physicians agreed with overall process. PRACTICE IMPLICATIONS Key factors for a successful RTD program is tailoring to institutional and individual needs.

Abstract 595: Heterogeneity of immune checkpoint expression in lung cancer identified through rapid tissue donation

Background: Translational research in advanced lung cancer is hindered by the limited availability of specimens for advanced molecular techniques. Although helpful, the standard practice to biopsy a small amount of tissue from a single site of cancer provides limited information. We launched a thoracic rapid tissue donation (RTD) program to enable lung cancer research with collection of tissue at multiple tumor sites within hours after death. Many patients chose to enroll in the RTD program as an opportunity to contribute to cancer research. RTD tissue will support multiple research projects, such as studying differential expression of immune checkpoint proteins in immune oncology or understanding resistance to targeted agents. Methods: The RTD program for patients with stage IV lung cancer was approved in June 2015 by the Moffitt Cancer Center institutional review board. Tissue specimens from multiple tumor sites from consented donors are collected rapidly (aim