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Impact on Outcomes of Unmet Needs in NSCLC Treatment


Specialists discuss unmet needs that continue to exist in treating patients with NSCLC despite advances in treatment, and how these impact patient outcomes.

David Carbone, MD, PHD: Let's now transition to unmet needs and barriers in the management of lung cancer. I've asked that question a lot, and I usually turn it around and say, let me list the Met needs in lung cancer because there's basically no space in lung cancer where there are no unmet needs. Even in resection of the 2 centimeter nodules, there are relapses with SBRT of 2 centimeter nodules. There are relapses. There's an unmet need in every aspect. Who wants to chime in on that subject?

Erin A. Gillaspie, MD, MPH, FACS: I mean, I think it goes all the way back to the very beginning at diagnosis. We can't even make screening available to everybody. Even starting at a very simple place and having easier access to screening, better follow-up for screening, especially targeting some of the more rural populations or underrepresented minorities. Also, acknowledging that a lot of the studies are not truly representative of our populations. We're taking a lot of data and applying it to the best of our ability, but it's not meeting the needs of our entire population. Finding ways to do every aspect of care from screening all the way through for our patients in a richer and more available.

David Carbone, MD, PHD: There are whole counties in Ohio where there are no cancer screening facilities. We've just gotten approval to operate a mobile lung cancer screening unit, and I'm very happy about that. But then you have to follow that up with these are underserved areas that may not have good thoracic surgeons or good pulmonary care. That's clearly a huge unmet need. A 5% or 6% screening rate for eligible patients, even with the current eligibility requirements, is appalling. Hospitals should be held accountable for those kinds of low numbers. That still doesn't help the patients who are ineligible by current criteria for screening, where many lung cancers arise in patients who've never smoked or have light smoking histories. We really need to find another huge unmet need is trying to figure out how to screen those patients. The pushback that I hear is that we might find a nodule, and that will cause emotional stress in these patients, I'm not sure that holds water for me because, you know, when you get lung cancer and you die from it, that's pretty strong emotional distress. I'd rather know about an ideal and follow it than not know about it.

Salma Jabbour, MD, FASTRO: People who live in locations that don't have access to hospitals, to all the necessary medical care. I think that obviously, these patients don't have access to multidisciplinary tumor boards, all the necessary components to clinical trials. I feel that we're very fortunate, most of us, to work in these centers that can focus on lung cancer, but many situations don't have that resource and just the access to care. We know that patients who can be identified for trials are probably going to have better outcomes because maybe their doctors are more equipped to care for them. There are barriers within our country from institution to institution.

David Carbone, MD, PHD: We need to recognize those. I think you hinted at how the criteria for screening, for example, were based on a predominantly white population. We need to look into other populations for risk factors that may influence their risk of lung cancer and maybe should be included in the calculation for eligibility. We talked about the mobile CT screening approach. We have a center for cancer health equity in our place that really is trying to work on these kinds of issues and working with the federally qualified health centers in Appalachia and Ohio to improve screening rates and access to health care in general. But it's a difficult problem. One thing is to define the optimal state of care, but it's a totally different thing to implement that in the general population. We've totally failed to do that with lung cancer screening as an example. But it applies to all aspects of care, expert surgical care, expert radiation care, and access to novel drugs. If doctors don't do genetic testing, they'll never find the drivers. There's a lot of room for improvement. Dr Dietrich, what is the primary unaddressed quality of life burden that persists as an unmet need?

Martin Dietrich, MD, PhD: I like to think of the support infrastructure, long-term follow-up survivorship clinics. But I'm going to go 1 step short of this and say we're not reaching really the full amount of lung cancer outcomes that we want to see. The first step is for us to apply what we already know stringently, not in a 60% or 70% conversion rate, but really every patient, every time from stage 1 onward to stage 4 gets evidence-based standard of care therapy. This is not happening in lung cancer across the board with very good data on that. Then when these patients survive, they oftentimes survive with autoimmune side effects with the quality of life long-term impact of the disease. They do need a similar set up and deserve a similar infrastructure like the breast cancer patients that have been basically a long-term follow-up provider and don't necessarily ever cut ties from them in a meaningful way. Lung cancer certainly has no shortage of areas of needed improvement for this. My first one would be to make sure that every patient receives the optimal standard of care at each time. Lung cancer has a way to go in making this a reality.

David Carbone, MD, PHD: We've talked about clinical trials, exploring new treatments and combination regimens in early stage and metastatic, and we could talk about them all day. But I think a major problem is getting patients on those studies, trying to figure out pragmatic trials that don't exclude patients for silly reasons. Trials that allow patients with brain metastases, trials that allow patients who got one dose of methotrexate for rheumatoid arthritis 25 years before. We need to start thinking more about real-world populations in our trials and allowing these people into these trials and pushing the trials to prove or disprove the efficacy of these agents in a real-world population.

Transcript is AI-generated and reviewed by an AJMC editor.

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