Research presented at the OncLive National Fellows Forum on Lung Cancer highlighted critical areas in lung cancer management, including the time burden on patients participating in clinical trials, the growing impact of air pollution on lung cancer mortality, and the benefits of early palliative care integration for patients with non-small cell lung cancer (NSCLC).
Quantifying Time Toxicity in Lung Cancer Clinical Trials
Amanda Herrmann, MD, presented a study quantifying the time costs for patients in lung cancer clinical trials. The retrospective study, TIME TOX Lung, developed a standardized metric called time toxicity units (TTUs), where 1 TTU equals 30 minutes. Analyzing 32 clinical trial protocols supporting FDA approvals of 18 oral targeted lung cancer agents, the study found that the median total time toxicity score for all trials was 77.4 TTUs. Notably, trials from 2015-2024 had a significantly higher median TTU score of 80.0 compared to 40.3 for trials from 2005-2014 (P = .045).
Herrmann plans to expand the dataset to include all FDA-approved therapies for advanced or metastatic NSCLC and hopes TTUs can streamline clinical trial protocol development and inform patients about the potential time commitment before enrollment.
Air Quality's Evolving Impact on Lung Cancer Incidence
Chinmay Jani, MD, presented an observational study on the effect of air pollution and asbestos on lung cancer mortality rates. Analyzing data from the 10 most populous countries from 1990-2019, the study used joinpoint regression analysis to determine the estimated annual percentage change in asbestos and particulate matter air pollution. The data revealed that while the overall age-standardized mortality rate (ASMR) globally decreased from 27.3 to 25.2 per 100,000 individuals, it increased in India, China, Indonesia, Pakistan, and Nigeria.
Ambient particulate matter-associated ASMR increased significantly in China (3.4 to 8.8 per 100,000 individuals), India (0.7 to 1.7 per 100,000 individuals), and other countries. Jani noted that air pollution is becoming a major factor in lung cancer mortality, now representing nearly 20% of the proportional ASMR of these cancers globally.
Improving Palliative Care in NSCLC
Cameron Oswalt, MD, presented an analysis of the effects of palliative care timing on patient experience and end-of-life outcomes. The study included 152 patients diagnosed with metastatic NSCLC, dividing them into groups based on the timing of palliative care consult (early [0-2 months], intermediate [2-6 months], late [6+ months]) and the number of palliative care visits. The study found that patients who received early palliative care had longer time on hospice (median 53.6 days), lower rates of aggressive end-of-life care (43%), and lower rates of in-hospital deaths (14%) compared to other groups.
"We ultimately found that patients who saw palliative care early had longer time on hospice, lower rates of aggressive end-of-life care, and they had lower rates of in-hospital deaths compared with the other groups of patients," Oswalt said. He emphasized the importance of identifying and addressing barriers to palliative care referrals to improve patient experience and health system outcomes.
