Life In Lung Cancer Patients Research Articles

Antibiotic adoption effects on nutrition and quality of life in lung cancer patients undergoing radiotherapy and chemotherapy: A meta-analysis.

Lung cancer (LC) is one of the leading causes of death worldwide. Treatment methodologies such as chemotherapy and radiotherapy have improved patient survival rates. Nevertheless, these treatments can also lead to adverse reactions and impact patients' nutritional status and quality of life (QOL). Antibiotics are commonly used for treating infections, but there is still controversy regarding their potential adverse effects on LC patients. This work aimed to investigate the impact of antibiotic adoption on the nutritional status and QOL of LC patients undergoing radiotherapy or chemotherapy, providing valuable insights for the clinical management of LC. A meta-analysis approach was employed to comprehensively evaluate the relationship by synthesizing relevant literature. Published studies were identified through searches in databases such as PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI. The inclusion criteria encompassed randomized controlled trials, cohort studies, and cross-sectional studies. Assessment indicators included patient weight, BMI, hemoglobin levels, and QOL. Meta-analysis was conducted using software such as the Cochrane Collaboration and RevMan5.3. Heterogeneity was evaluated using the Higgins I2 index, where values between 25% and 50% indicate moderate heterogeneity, and values greater than 50% indicate substantial heterogeneity. 12 eligible studies involving 1,917 patients were finally included. LC patients who received antibiotics during radiotherapy or chemotherapy were found to have a higher risk of malnutrition. The antibiotic group exhibited a more significant decrease in body mass index (BMI) (P< 0.05) and lower serum albumin levels (P< 0.05) versus the control (C) group. Additionally, the overall QOL scores in the antibiotic group were dramatically lower than those in the C group, showing a significant difference with P< 0.05. Sensitivity analysis indicated that the overall conclusions of this work were robust and unbiased. Antibiotics in LC patients undergoing radiotherapy or chemotherapy may increase the risk of malnutrition and decrease their QOL. Hence, physicians should carefully consider antibiotics and take necessary preventive measures and supportive treatments to improve LC patients' nutritional status and QOL.

The effect of median household income on the prognosis of lung adenocarcinoma: A SEER analysis.

Lung cancer is the main cause of death related to malignant tumors. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine-Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significantly how socio-economic status influences initial treatment decisions and survival outcomes in patients with lung adenocarcinoma. The aim of this study was to identify the predictors of lung adenocarcinoma. The U.S. Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with lung adenocarcinoma between 2000 and 2018. Seventeen thousand four hundred forty-one patients with lung adenocarcinoma were subdivided in four socio-economic tertiles, based on median household income. Cox regression modeling explored the relationship between race, surgery, grading, and median household income on survival outcomes. The study also assessed patient demographic characteristics, age at diagnosis, and surgical interventions. Among 17441 patients with primary lung adenocarcinoma, the age distribution was as follows: less than 45 years (n=202, 1.16%), between 45 and 54 years (n=1121, 6.43%), 55 and 64 years (n=4252, 24.38%), 65 and 74 years (n=6357, 36.45%), 75 and 84 years (n=4426, 25.38%), and more than 84 years (n=1083, 6.2%). The adjusted hazard ratio (aHR) with 95% CI for ages 65-74 years, 75-84 years, and older than or equal to 85 years were 0.25 (0.11,1.29), 0.40 (0.11,1.50), and 0.72 (0.11,2.05), respectively. Multifactorial Cox regression indicated that the aHR for tumor metastasis was 0.93 (0.03, 2.54), and for patients who did not undergo surgery, it was 1.46 (0.03, 4.31). Grade IV patients exhibited the lowest survival rate [0.66(0.11, 1.93)]. A notable correlation existed between median household income and survival, with distinctly lower survival rates observed in low-income groups. Older patients, especially those who did not undergo surgery and had a higher tumor grade, had significantly reduced survival. Moreover, survival rates for black patients in lower-income brackets were worse than those for white patients in the same financial category. The quality of life of lung cancer patients is affected by low-income family.

Effects of Symptom Burden on Quality of Life in Patients with Lung Cancer.

Lung cancer patients suffer from numerous symptoms that impact their quality of life. This study aims to identify the symptom burden on quality of life in lung cancer patients. This survey used a structured questionnaire to collect data from 8 March 2021 to 12 May 2021. Patient demographic information was collected. The data on symptom burden and quality of life (QOL) of patients were obtained from the QLQ-C30 and the QLQ-LC13. The stepwise multiple regression analysis was used to estimate lung cancer-related symptom burden in relation to quality of life. The study included 159 patients with lung cancer who completed the questionnaire. The mean age of the patients was 63.12 ± 11.4 years, and 64.8% of them were female. The Global Quality of Life score of the QLQ-C30 was 67.87 ± 22.24, and the top five lung cancer-related symptoms were insomnia, dyspnea, and fatigue from the QLQ-C30, and coughing and dyspnea from the QLQ-LC13. The multiple regression analysis showed that appetite loss was the most frequently associated factor for global QOL (β = -0.32; adjusted R2: 27%) and cognitive function (β = -0.15; adjusted R2: 11%), while fatigue was associated with role function (β = -0.35; adjusted R2: 43%), emotional function (β = -0.26; adjusted R2: 9%), and social function (β = -0.26; adjusted R2: 27%). Dyspnea was associated with physical function (β = -0.45; adjusted R2: 42%). Appetite loss, fatigue, and dyspnea were the main reasons causing symptom burdens on quality of life for lung cancer patients. Decreasing these symptoms can improve the quality of life and survival for patients with lung cancer.

Scoping review of anticancer drug utilization in lung cancer patients at the end of life.

This scoping review aims to deepen the understanding of end-of-life anticancer drug use in lung cancer patients, a disease marked by high mortality and symptom burden. Insight into unique end-of-life treatment patterns is crucial for improving the appropriateness of cancer care for these patients. Comprehensive searches were carried out in Medline and Embase to find articles on the utilization of anticancer drugs in the end of life of lung cancer patients. We identified 68 publications, highlighting the methodological characteristics of studies including the timing of the research, disease condition, treatment regimen, type of treatment, and features of the treatment. We outlined the frequency of anticancer drug use throughout different end-of-life periods. This review provides a comprehensive overview of primary studies exploring end-of-life treatments in lung cancer patients. Methodological inconsistencies pose many challenges, revealing a notable proportion of patients experiencing potential overtreatment, warranting more standardized research methods for robust evaluations.

Influence of Financial Toxicity on the Quality of Life in Lung Cancer Patients Undergoing Immunotherapy: The Mediating Effect of Self-Perceived Burden.

The purpose of this study is to understand the level of quality of life (QOL) of lung cancer patients receiving immunotherapy and to clarify the potential mediating role of self-perceived burden (SPB) in the relationship between financial toxicity (FT) and QOL. A convenience sample of 342 lung cancer patients receiving immunotherapy was recruited from a cancer hospital from October 2022 to April 2023 for this cross-sectional study. The participants were requested to complete the following structured questionnaires: a sociodemographic and clinical questionnaire, the Functional Assessment of Cancer Therapy-Lung (FACT-L), the Self-Perceived Burden Scale (SPBS) and the COmprehensive Score for Financial Toxicity (COST). The data were subjected to Pearson correlation analysis and bootstrapping analysis in structural equation modelling. The total FACT-L score was 79.90±15.84 points in 322 lung cancer patients receiving immunotherapy. FT (β = 0.37, P < 0.01) and SPB (β = -0.27, P < 0.01) had a direct effect on QOL. In addition, SPB partly mediated the association between FT and QOL, and the standardized indirect effect was 0.19, accounting for 33.9% of the total effect. The present study revealed that there is still much room for improvement in the QOL of lung cancer patients during immunotherapy. A greater financial burden resulted in a greater self-perceived burden and was thus associated with inferior QOL. It is imperative for oncology nurses to routinely assess QOL, FT or risk and SPB for lung cancer patients undergoing immunotherapy as well as to assist those patients in understanding the potential financial risk of each choice and help them take more active roles in their routine clinical care.

Chinese Expert Consensus on Perioperative Pulmonary Rehabilitation Training for Lung Cancer

Perioperative pulmonary rehabilitation may effectively reduce the incidence of postoperative pulmonary complications and improve the quality of life of lung cancer patients and its clinical application value in lung cancer patients has been widely recognized. However, there is still no international consensus or guideline for pulmonary rehabilitation regimen, lacking standardized criteria when pulmonary rehabilitation applied in perioperative clinical practice for lung cancer. The consensus provides implementation regimen and process of pulmonary rehabilitation, aiming to promote the reasonable and standardized application of perioperative pulmonary rehabilitation training in clinical practice, sequentially enable patients to maximize benefits from the rehabilitation. .

Analyzing diagnostic and treatment wait times for lung cancer Patients: Key insights from a provincial registry study

BackgroundLung cancer (LC) remains the leading cause of cancer-related mortality globally, necessitating timely diagnosis and treatment to improve patient outcomes. This study aimed to evaluate the timeliness of care for LC patients at a public hospital in Almería, Spain, assess adherence to guidelines, and explore associations between timeliness and survival. MethodsA retrospective cohort study was conducted, reviewing medical records of LC patients diagnosed between 2019 and 2021. Quality indicators, adapted from prevailing guidelines, facilitated the assessment of care timeliness, with a focus on diagnostic and treatment wait times. Cox regression modeling was employed to explore survival associations, adjusting for covariates including age, performance status, stage, histology, and treatment modalities. ResultsOf 539 patients included, most (79.84 %) had initial specialist contact within 7 days, and 82.25 % received diagnosis within 30 days. However, delays were observed in treatment initiation, with surgery experiencing the longest median wait time (78 days). Survival analysis showed no significant difference between shorter and longer diagnostic (HR: 0.87, 95 % CI: 0.62–1.24) or treatment intervals (HR: 1.14, 95 % CI: 0.83–1.58). Multivariate analysis identified age, performance status, stage, histology, and treatment as prognostic factors. ConclusionThis study highlights the importance of timely diagnosis and treatment in improving lung cancer outcomes. Despite achieving diagnostic targets, treatment delays were common, particularly for surgical interventions. These findings underscore the need for enhanced coordination and efficient care pathways to minimize delays, ultimately improving survival rates and quality of life for lung cancer patients. Addressing these issues is crucial for optimizing lung cancer care delivery in the future.

Stigma and quality of life in lung cancer patients: The mediating effect of distress and the moderated mediating effect of social support

ObjectiveThis study aimed to investigate the mediating effect of distress on the relationship between stigma and quality of life (QOL) in lung cancer patients, and to explore the moderated mediating effect of social support. MethodsA total of 184 individuals diagnosed with primary lung cancer participated in the study. Data on general and disease-related characteristics, stigma, distress, QOL, and social support were collected using a comprehensive structured questionnaire. Medical records were also utilized for an in-depth analysis of disease-related attributes. The data were meticulously analyzed using the SPSS PROCESS macro ver. 3.4 for detailed insights. ResultsThe findings elucidated a clear pathway whereby stigma negatively impacted patients' QOL through the mediating effect of distress. Interestingly, the extent of this impact was significantly influenced by the presence of friendship support, underscoring its unique moderated mediating role. Conversely, support from family and health care professionals did not demonstrate a significant influence in this context. ConclusionsThese findings underscore the importance of addressing stigma and distress to improve the QOL of lung cancer patients. The study highlights the pivotal role of friendship support in moderating this relationship, suggesting the need for tailored interventions to strengthen social networks. These insights provide valuable guidance for developing more nuanced and effective patient support strategies in oncology care.

Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer.

Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed. Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.

Exploring patient reported quality of life in lung cancer patients: A qualitative study of patient-reported outcome measures.

Lung cancer is the leading cause of cancer-related death globally and provides a major disease burden likely to substantially impact quality of life (QoL). Patient-reported outcome measures (PROMs) have been identified as effective methods of evaluating patient QoL. Existing lung cancer-specific PROMs however have uncertain utility and minimal patient involvement in their design and development. This qualitative study aimed to evaluate the patient perspective of existing PROMs and to explore their appropriateness for population-based descriptions of lung cancer-related QoL. A descriptive qualitative study was conducted consisting of semi-structured interviews with 14 patients recruited from the Victorian Lung Cancer Registry and Alfred Hospital using purposive sampling. Interviews first explored the factors most important to lung cancer patients QoL, and second, patient's perspectives on the appropriateness of existing PROMs. Thematic analysis was used to develop themes, and content analysis was conducted to determine PROM acceptability. Five novel themes were identified by patients as being important impacts on QoL: Personal attitude toward the disease is important for coping; independence is valued; relationships with family and friends are important; relationships with treating team are meaningful; personal and public awareness of lung cancer is limited. These patient-identified impacts are poorly covered in existing lung cancer-specific PROMs. Patients welcomed and appreciated the opportunity to complete PROMs; however, they identified problems with existing PROMs relevance, tone, and formatting. Existing lung cancer PROMs poorly reflect the five themes identified in this study as most important to lung cancer patients QoL. This study reaffirms the need to review existing PROMs to ensure utility and construct validity. Future PROM development must engage key patient-generated themes and evolve to reflect the changing management and therapeutic landscape.

Effects of transitional care interventions on quality of life in people with lung cancer: A systematic review and meta-analysis.

To identify and appraise the quality of evidence of transitional care interventions on quality of life in lung cancer patients. Quality of life is a strong predictor of survival. The transition from hospital to home is a high-risk period for patients' readmission and death, which seriously affect their quality of life. Systematic review and meta-analysis. The PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases were searched from inception to 22 October 2022. The primary outcome was quality of life. Statistical analysis was conducted using Review Manager 5.4, results were expressed as standard mean difference (SMD) with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Cochrane risk of bias assessment tool. This study was complied with PRISMA guidelines and previously registered in PROSPERO (CRD42023429464). Fourteen randomized controlled trials were included consisting of a total of 1700 participants, and 12 studies were included in the meta-analysis. It was found that transitional care interventions significantly improved quality of life (SMD = 0.21, 95% CI: 0.02 to 0.40, p = .03) and helped reduce symptoms (SMD = -0.65, 95% CI: -1.13 to -0.18, p = .007) in lung cancer patients, but did not significantly reduce anxiety and depression, and the effect on self-efficacy was unclear. This study shows that transitional care interventions can improve quality of life and reduce symptoms in patients, and that primarily educational interventions based on symptom management theory appeared to be more effective. But, there was no statistically significant effect on anxiety and depression. This study provides references for the application of transitional care interventions in the field of lung cancer care, and encourages nurses and physicians to apply transitional care plans to facilitate patients' safe transition from hospital to home. No Patient or Public Contribution.

Physiotherapy Interventions in Lung Cancer Patients: A Systematic Review.

Lung cancer is a very common disease and leads to a series of sequelae such as reduced lung capacity or reduced functional capacity in patients, which are associated not only with the disease itself, but also with medical treatment. Thus, physiotherapeutic interventions are needed to improve quality of life and reduce these symptoms. To find out the effects of physiotherapy on functional capacity, lung capacity, dyspnea, pain, and quality of life in lung cancer patients. A systematic review was carried out in five databases. Randomized clinical trials published between 2019-2023 were selected, in which the physiotherapeutic treatment was physical exercise and/or respiratory physiotherapy. Nine articles were included, in which the total sample consisted of 635 lung cancer patients. When combined, respiratory physiotherapy and physical exercise improved functional capacity and lung capacity (p < 0.05). Dyspnea also improved, but less significance was shown in the included studies. Multimodal physiotherapy interventions may offer benefits for some lung cancer patients, but the extent and nature of these benefits may vary depending on the intervention applied. Therefore, it would be of great interest to carry out further scientific research to support this conclusion.

Relationship between pain and quality of life in lung cancer patients

Background: The interest of quality of life remains a high priority subject on cancer patients. Pain has been recognized as a key symptom in various types of cancer; pain affects all aspects of quality of life and aggravates other symptoms. In the treatment and care of patients, nurses play an important role in assessing, supporting and helping to improve the quality of life of cancer patients. Objective: To survey the relationship between pain severity and average score of quality of life in lung cancer patients. Material and method: Descriptive cross-sectional study was conducted on 102 lung patients at all stages treated at Gynecology and Lung Department of Ho Chi Minh City Oncology Hospital from 3 - 6/2022. EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires were used to investigate quality of life, pain severity was assessed by the BPI-sf self-assessment questionnaire. Results: Pain prevalence was 52% in lung cancer patients at all stages; among them, mild pain was 41.5%, moderate pain was 49.1% and severe pain was 9.1%. The average score of global health status scored was 64.9 points. Functional aspects had average scores from 56.5 - 89.7 points. The most prominent symptoms are fatigue, appetite loss and insomnia. There was a correlation between pain severity (BPI-sf) and the average score of global health status, social, physical, role functioning and symptoms of fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, constipation, haemoptysis, dysphagia (EORTC QLQ-C30 and EORTC QLQ-LC13). Conclusion: Global health status and the ability of performing social, physical and role functioning decreased with increased pain. Conversely, other symptoms worsened on the increase in pain severity. Key words: lung cancer, quality of life, pain.

Quality of life of lung cancer patients

Abstract Lung cancer is one of the most prevalent forms of cancer in patients in Ukraine. The objective of the study was to identify the main problems in the quality of life of patients with lung cancer in order to optimize medical care for this patient group. A survey of 411 patients of oncology institutions in nine regions of Ukraine was conducted in the period from November 2021 to February 2022. The sociological survey was performed using the EORTC QLQ-C30 and QLQ-LC29 questionnaires. As of the pre-war period, the quality of life of lung cancer patients in Ukraine amounted to 49.12 points on a 100-point scale. According to the QLQ-C30 symptom scale, the highest score among the complaints of Ukrainian patients is that of financial difficulties, the second place is occupied by fatigue. According to the QLQ-LC29 symptom scale, patients with lung cancer were most concerned with “Fear of progression”. Ukrainian patients were least concerned about diarrhea and hemoptysis. When providing medical care to cancer patients, components to ensure the proper quality of their lives and psychosocial care, including the standardization of psychological care and its introduction in all institutions that provide medical care to cancer patients; organization of social and psychological support for cancer patients and their families; as well as educational work with relatives, colleagues, medical professionals on awareness of the need for social and psychological support for patients must be taken into account.

Smoking and quality of life in lung cancer patients: systematic review

ObjectivesLung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor...

The impact of comorbidities, neutrophil-to-lymphocyte ratio, and drug toxicities on quality of life in lung cancer patients receiving EGFR-TKI therapy

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are used as the standard first-line treatment for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, the impact of comorbidities and treatment toxicities on quality of life (QoL) was seldom investigated. We aimed to investigate the association of comorbidities, adverse events (AEs), and QoL in treatment-naïve advanced NSCLC patients receiving EGFR-TKI treatments. This multi-center prospective observational study was conducted to evaluate QoL and AEs at baseline, the 2nd, 4th, 12th, and 24th week. Clinical characteristics, comorbidities, and pre-treatment laboratory data were recorded. QoL was assessed by using the summary score of the EORTC QLQ-C30 and the dermatology life quality index. The impact of comorbidities, neutrophil-to-lymphocyte ratio (NLR), and AEs on QoL was analyzed by generalized estimating equations. A total of 121 patients were enrolled. Diarrhea (p=0.033), anorexia (p<0.001), and NLR ≥4 (p=0.017) were significantly associated with a QoL impairment. Among skin toxicities, acneiform rash (p=0.002), pruritus (p=0.002), visual analogue scale for pruritus (≥3 and<7, p=0.006; ≥7, p=0.001) and pain (1-3, p=0.041) were associated with a QoL impairment. No significant association was found between comorbidities and QoL changes. Diarrhea, anorexia, skin pain, and pruritus may cause a deterioration in QoL in patients receiving EGFR-TKI therapy. NLR may be a potential predictive factor for QoL impairment. Aggressive management and close monitoring for these clinical factors are crucial to improve QoL.

Evo-GUNet3++: Using evolutionary algorithms to train UNet-based architectures for efficient 3D lung cancer detection

The early detection of malignant lung nodules can strongly increase the chances of life in lung cancer patients. A computer tomography scan represents an effective way to identify and locate malignant nodules in the body and monitor their growth. However, the reading and interpretation of tomography scans are subject to errors that can be reduced with a second reader. The adoption of image processing systems can reduce the possibility of errors and can support radiologists in ensuring multiple readings of tomography scans. This study proposes a new approach for accurate 3D lung nodule detection starting from computer tomography scans. This work exploits an evolutionary algorithm to build variants of a UNet-based architecture, called GUNet3++, to detect patients affected by lung cancer, from the analysis of CT-scan images of lungs. The approach is validated on the LIDC-IDRI real dataset and results show that it improves segmentation quality metrics (IoU and Dice) over baselines, leading to better 3D models reconstruction of lesions.

Factors Associated with Poor Quality of Life in Lung Cancer Patients Undergoing Chemotherapy in Erbil City

Background and aims: Lung cancer is one of the most prevalent types of cancer in the world, and the aim of the study was to determine the quality of life. and its related factors in lung cancer patients undergoing chemotherapy. Methods: A descriptive cross-sectional study design was conducted in Iraq in 2022 on 100 cancer patients undergoing chemotherapy who were randomly collected in Rizgary Teaching Hospital and Nanakaly Hospital for blood disease and cancer. The instrument used for data collection consisted of demographic and medical data (age, gender, educational level, marital status, occupation, economic status, residency, cigarette smoking, family history, stages of lung cancer, and types of lung cancer), another section was the functional assessment of cancer therapy-lung questionnaire (FACT-L), specifically designed for the measurement of quality of life in patients with lung cancer. Categorical data were presented as frequency and percentage and the mean± SD was calculated for continuous data, independent t-test, and Chi-square test was also used; Binary logistic regression was run to determine the effect of the predictors on poor quality of life in lung cancer patients a P-value ≤0.05 was considered statistically significant. Results: The overall quality of life was poor (59%), the mean± SD for Functional Assessment of Cancer Therapy Lung Cancer Subscale (FACT-L) was 66.19 ± 10.54, and Trial Outcome Index (TOI) was 39.77±5.51, The following variables were associated with a poor quality of life: age &gt;50 (P-value =0.020, OR= 2.47), female (P-value =0.006, OR= 3.02), uneducated (P-value =0.0005, OR= 1.86), ex-smoker (P-value =0.040, OR= 2.14), insufficient income (P-value =0.037, OR= 2.69). Conclusion: The quality of life of lung cancer was lower in physical well-being, functioning well-being, and lung cancer subscale compared to social/family well-being, and emotional well-being, as generally, the quality of life of most lung cancer patients was poor.

The Tian-Men-Dong decoction suppresses the tumour-infiltrating G-MDSCs via IL-1β-mediated signalling in lung cancer

Ethnopharmacological relevanceThe traditional Chinese medicine (TCM) Tian-Men-Dong decoction (TD) has been able to effectively treat lung cancer in China for thousands of years. TD improves the quality of life in lung cancer patients by promoting nourishment of yin and reducing dryness, clearing the lung and removing toxins. Pharmacological studies show that TD contains active antitumour ingredients, but its underlying mechanism remains unknown. Aim of the studyThis study aims at exploring potential mechanisms of TD in the treatment of lung cancer by regulating granulocytic-myeloid-derived suppressor cells (G-MDSCs). Materials and methodsAn orthotopic lung cancer mouse model was generated by intrapulmonary injection with LLC-luciferase cells in immunocompetent C57BL/6 mice or immunodeficient nude mice. TD/saline was orally administered once to the model mice daily for 4 weeks. Live imaging was conducted to monitor tumour growth. Immune profiles were detected by flow cytometry. H&E and ELISA were applied to test the cytotoxicity of the TD treatment. RT–qPCR and western blotting were performed to detect apoptosis-related proteins in G-MDSCs. A neutralizing antibody (anti-Ly6G) was utilized to exhaust the G-MDSCs via intraperitoneal injection. G-MDSCs were adoptively transferred from wild-type tumour-bearing mice. Immunofluorescence, TUNEL and Annexin V/PI staining were conducted to analyse apoptosis-related markers. A coculture assay of purified MDSCs and T cells labelled with CFSE was performed to test the immunosuppressive activity of MDSCs. The presence of TD/IL-1β/TD + IL-1β in purified G-MDSCs cocultured with the LLC system was used for ex vivo experiments to detect IL-1β-mediated apoptosis of G-MDSCs. ResultsTD prolonged the survival of immune competent C57BL/6 mice in an orthotopic lung cancer model, but did not have the same effect in immunodeficient nude mice, indicating that its antitumour properties of TD are exerted by regulating immunity. TD induced G-MDSC apoptosis via the IL-1β-mediated NF-κB signalling cascade leading to effectively weaken the immunosuppressive activity of G-MDSCs and promote CD8+ T-cell infiltration, which was supported by both the depletion and adoptive transfer of G-MDSCs assays. In addition, TD also showed minimal cytotoxicity both in vivo and in vitro. ConclusionThis study reveals for the first time that TD, a classic TCM prescription, is able to regulate G-MDSC activity and trigger its apoptosis via the IL-1β-mediated NF-κB signalling pathway, reshaping the tumour microenvironment and demonstrating antitumour effects. These findings provide a scientific foundation the clinical treatment of lung cancer with TD.

Abstract 4260: Understanding genomic and social determinants of cancer immunotherapy outcome across ancestry

Abstract Compared with previous standards of care, the use of immune checkpoint inhibitors (ICI) has brought significant improvements in survival and quality of life for lung cancer patients. However, only a small proportion of these patients respond durably. People with different ancestries differ probabilistically in genetic factors, environmental exposures, and socio-economic conditions. Whether patients of different ancestry benefit equally from ICIs remains unclear. We studied the impact of genomic ancestry, tumor genomics, and social determinants of health (SDH) factors and factors that are impacted from SDH including recorded race/ethnicity, inferred low-income status from patient zip codes, exposure to smoking, and BMI on ICI response, defined by cancer progression-free survival (PFS, minimum 6 months FU), for non-small cell lung cancer (NSCLC) patients with MSK-IMPACT targeted panel sequencing. This FDA approved assay includes matched tumor-white blood cell sequencing to distinguish germline from somatic variants and has been applied to 1,802 NSCLC patients who received ICI treatment, including 81 and 117 patients with at least 80% of African (AFR) and East Asian (EAS) ancestry, respectively. Moreover, 173 samples were derived from admixed patients with more than one major ancestry. We first used a natural language processing (NLP) model to obtain PFS from free-text clinical notes. A multivariable cox proportional hazard model was then used to associate PFS with ancestry, race, smoking status, ICI drug regimen, PD-L1 status, disease stage, tumor mutational burden (TMB), inferred income, and BMI. Neither genetic ancestry nor self-reported race/ethnicity was associated with the PFS. Moreover, ICI drug regimen types, low-income status, and BMI were not associated with PFS in our cohort. TMB-high was associated with longer PFS across all ancestries, although TMB was lower in patients with EAS ancestry (Median 7.9 vs. 5.3 mut/Mb, p&amp;lt;0.001). These results suggest that the benefits of ICI extend across ancestry, race, and income lines in a single institution, arguing for more equitable patient access to these medications. We also show that TMB is a generalizable biomarker for ICI outcome across ancestries. However, more diverse patient populations are needed to understand whether there is ancestry-specificity in other ICI outcome biomarkers. Citation Format: Christopher J. Fong, Michele Waters, Karl Pichotta, Justin Jee, Devika R. Jutagir, David Ma, Tomin Perea-Chamblee, Susie Kim, Kanika Arora, Brooke Mastrogiacomo, Thinh Tran, Steven Maron, Mirella Altoe, Anisha Luthra, Joseph Kholodenko, Arfath Patha, Doori Rose, Michael F. Berger, Gregory J. Riely, Nikolaus Schultz, Sanna Goyert, Adam Schoenfeld, Francesca Gany, Jian Carrot-Zhang. Understanding genomic and social determinants of cancer immunotherapy outcome across ancestry. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4260.