Sample Of Lung Cancer Patients Research Articles

Lung cancer registry to promote person-centered care. 

Introduction: Lung cancer is a leading cause of death and major burden on healthcare systems. Patient-centered outcome measurements allow the optimization of care organization and quality improvement. The aim of this project was to outline a set of variables and outcomes to evaluate the quality of care provided to lung cancer patients. 
 Methods: This project took place at Hospital Italiano de Buenos Aires, a community-based tertiary care hospital in Argentina; which provides thoracic surgery, pneumology, oncology, pathology, radiology and radiotherapy services. It also has a Lung Cancer Multidisciplinary Board. All patient information is stored in a Data Repository fed by the electronic health record (EHR).
 We established a team of experts in management, IT, thoracic surgery, pneumology, oncology, and internal medicine. We reviewed care processes and patient trajectory along the usual pathway, through a retrospective EHR analysis of a consecutive sample of lung cancer patients. 
 We performed a literature review to outline possible variables and health outcomes to be collected, instruments, and frequency of measurement. We determined needs, usefulness, and feasibility of collecting variables and outcomes in group meetings. 
 Results: We reviewed 15 cases of lung cancer, 53% male, median age 68 years old (range: 29-85). We detected heterogeneity in the time elapsed between critical points of management (eg first visit to diagnosis 21 to 642 days; biopsy report to chemotherapy 19 to 163). The proportion of use of the healthcare system was also variable (eg: 87% consulted pneumonolory or oncology, only 13% had pain management visits and 7% received respiratory kinesic therapy). Patient-reported outcomes were not systematically evaluated.
 The selected baseline variables were: age, sex, weight loss, smoking status, comorbidities, patient-reported health status (EORTC European Organization for Research and treatment of cancer, QLC-LC30 Core quality of life questionnaire, QLC-LC13 Lung cancer-specific quality of life questionnaire), performance status (ECOG Eastern Cooperative Oncology Group), pulmonary function (VEF1), histology, clinical and pathological stage (AJCC-TNM 8th Ed), molecular tests and treatment intent. The outcomes (collected annually): clinical staging performed before treatment, time from diagnosis to treatment, performance status, patient-reported health status, major surgical complications, major chemotherapy/radiotherapy complications, time from diagnosis to treatment, completed treatment, overall survival, cause of death, treatment-related mortality, place of death, time spent in hospital at the end of life (last 30 days).
 Discussion: Cancer registries comprise a set of systematically and prospectively collected data. Quality measurements performed in the context of cancer registries could assist in monitoring and evaluating quality of care. 
 Conclusions: The project determined essential variables and outcomes to be measured, considering their relevance and feasibility.
 Lessons learnt: Teamwork is essential when developing a registry, as different stakeholders' opinions are reflected. Integrated care is a useful solution to overcome fragmentation.
 Limitations: Patients did not participate directly in this development. 
 Suggestions for future research: These results will assist in outlining a care pathway for patients with lung cancer, which is currently under development. Evaluation before and after the implementation of care pathways may evidence quality improvement.

The association of demographic factors and disease stage on palliative care (PC) referral rates and completion of advanced directives in a lung cancer (LC) patient population.

e24150 Background: Early referral to PC improves quality of life among patients with lung cancer and is associated with improvement in overall survival in patients with stage 4 disease. However, PC utilization remains low. Few studies examined the disparities in PC access and use in real life SCLC and NSCLC patient populations. Objective: To determine the prevalence of PC use among a sample of LC patients and assess the role of PC in facilitating directives and goals of care discussion. Methods: A retrospective cohort analysis was conducted utilizing a randomly selected subset of LC patients treated at the IU Simon Comprehensive Cancer Center between 1/1/18 and 12/31/20. We collected information on advanced directives in the form of designated medical decision maker (Healthcare representative or Healthcare power of attorney) and code status preferences (DNR or POST form). Signed DNR order/POST forms information, demographics (sex, race), LC stage, and LC type were analyzed using descriptive analyses. Chart search identified the dates of first palliative care visit and number of total palliative care visits. Results: Patient characteristics (n = 209): Females 51.7%; White 86.7%; NSCLC 88.5%; stage IV 44.1%. The percentage of total patients who were referred to palliative care was 21.1%. No significant difference in referral rates was found between NSCLC and SCLC patients. 22.3% of male patients and 19.8% of female patients were referred to PC (p = 0.61). No difference was noted in the percentage of white and non-white patients referred to PC (21% and 26.1%, p = 0.97). Palliative referral rates and time from diagnosis to first palliative contact was significantly associated with disease stage, as 27.9% of patients with stage 4 were referred to palliative compared to 15.6% of patients with stages 1-3 (p = 0.036); median time from diagnosis to first palliative contact in stage 4 patients was 355.7 days vs 573.7 days in stages 1-3. Disease stage was associated with the median time from diagnosis to signing POST/DNR forms: 213.6 days in stage 4 patients vs. 409.1 days in stage 1-3 patients. Discussing and signing POST/DNR and HCPOA/HCR forms was associated with palliative care referrals; 53.7% and 63.6% of those referred to palliative signed POST/DNR and HCPOA/HCR forms respectively vs. 11.4% and 16.9% for patients who were never referred to PC. Conclusions: Stage 4 LC was associated with higher likelihood of referral to palliative care than stages 1-3 but PC was underutilized in LC. Demographic factors (race, sex) were not significantly associated with PC referral rates. Patients referred to PC were more likely to address advanced directives than patients who were never offered PC. Strategies to increase palliative care utilization and barriers limiting PC utilization in LC patients need to be further investigated.

Comparing the Accuracy of Seven Scoring Systems in Predicting Survival of Lung Cancer Patients With Spinal Metastases: An External Validation From Two Centers.

Retrospective case series. To investigate the accuracy of seven scoring systems for the prediction of survival in lung cancer patients with spinal metastases (SPM). Although survival scoring systems have been developed for surgical decision-making, the reliability and validity of these models are unclear for specific cancer types. As the prevalence of patients with lung cancer increases, it is imperative to determine the accuracy of these models for lung cancer patients with SPM. This is a retrospective study of a cohort of lung cancer patients with SPM who underwent spine surgery between 2019 and 2021 at two centers. The optimal area under the curve (AUC) was calculated to evaluate the accuracy of seven candidate scoring systems at 3, 6, and 12 months. Calibration and decision curve analysis was used for further validation. A total of 166 patients (mean age: 58.98±10.94; 105 males and 61 females) with SPM were included. The median postoperative survival was 12.87±0.93 months. The modified Bauer score, revised Tokuhashi score, Linden score, Tomita score, the Skeletal Oncology Research Group nomogram, and the New England Spinal Metastasis Score in prediction survival at 3, 6, and 12 months showed a slightly weaker AUC (range 0.464-0.659). The AUC of the Katagiri-New score in predicting 1-year survival for lung cancer patients was the highest (0.708; range 0.619-0.798). The decision curve analysis showed that the Katagiri-New score led to a greater net benefit than the strategies of changing management for all patients or none of the patients. This study suggests that the most commonly used models have limitations in predicting survival in patients undergoing spinal surgery for metastatic lung cancer and underestimate survival. In this sample of lung cancer patients, the Katagiri-New Scoring system score had the best performance in predicting 1-year survival. 4.

Understanding the experiences of lung cancer patients during the COVID-19 pandemic: a qualitative interview study

PurposeThe study explores experiences of lung cancer patients during COVID-19 and considers how changes to care delivery and personal lives affected patient needs.MethodsSemi-structured telephone interviews were conducted to explore experiences of lung cancer patients during COVID-19. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Interview participants were purposively selected based on age, gender, treatment status, timing of diagnosis (pre/post first COVID-19 lockdown) from a sample of lung cancer patients (any histological subtype/any cancer stage/any point in treatment) who had completed a questionnaire exploring how participants’ lives were impacted by the pandemic and their thoughts on clinical care and remote communication.ResultsThirty lung cancer patients who participated in the questionnaire study were approached and participated in an interview. Three themes were identified: (1) Adapting to new modes of communication (focusing on experiences of remote communication); (2) Experience of care delivery during the pandemic (describing how all aspects of care delivery had been affected); (3) Impact of the COVID-19 pandemic on quality of life (QOL) (focus on the psychological impact and feeling of reduced support). Themes 1 and 2 are heavily interlinked and both had bearing on patients’ QOL experience.ConclusionLung cancer patients were impacted psychologically by changes to care delivery and changes in their personal life. The findings highlight some benefits to remote consultations but the stage of the treatment pathway and illness trajectory should be considered when determining if this is appropriate. Participants felt support from peers, family and friends was limited during the pandemic.

Systematic analysis the genomic and microenvironment characteristics with the status of human leukocyte antigen (HLA) and the integration of HLA LOH, TMB and PD-L1 could further distinguish the responders to immunotherapy.

e20529 Background: Although studies have shown that loss of heterozygosity (LOH) at the human leukocyte antigen (HLA) locus is one of the mechanisms of immune escape, the effect of HLA LOH on the immune checkpoint inhibitors (ICIs) treatment is still need to be further investigated, especially for the patients with positive programmed cell death-Ligand 1 (PD-L1) expression and high tumor mutation burden (TMB). Methods: 425 sample of Chinese lung cancer patients who received PD-L1 immunotherapy were performed with targeted panel sequencing to analyzed the genomic characteristics with HLA status. 994 non-small cell lung cancer (NSCLC) sample from The Cancer Genome Atlas (TCGA) were used to analyze the impact of HLA LOH on the tumor microenvironment. In addition, 89 samples from previous study were used to analyze the association of HLA status with the ICIs treatment in NSCLC. Results: The genomic characteristics from 425 sample of Chinese lung cancer patients who received PD-L1 immunotherapy were analyzed. We found that mutation frequency of driver genes and TMB in the HLA LOH high group were significantly increased. Transcriptome analysis revealed HLA LOH played a critical role in the tumor immune microenvironment in PD-L1+/TMB-H population and the impact on lung adenocarcinoma was greater than that on lung squamous cell carcinoma. Progression-free survival of PD-L1+/TMB-H population was significantly decreased in HLA LOH group which suggest that comprehensive considering HLA LOH as a biomarker may improve clinical response to immunotherapy. Conclusions: This work showed the genomic and immune microenvironment characteristics of HLA LOH and demonstrated HLA LOH as a significant negative predictor of outcomes after ICIs treatment, especially in PD-L1+/TMB-H population. These data suggested that comprehensive considering HLA LOH as a biomarker may improve clinical response to immunotherapy.

Systematic assessment of tumor mutational burden calculation across different sequencing platforms and cancer types and its implication in clinical decision-making.

2631 Background: Tumor mutation burden (TMB) has been validated as a biomarker to predict the response of immune checkpoint inhibitors (ICIs) treatment in various cancers. However, the effects of different sequencing platforms, cancer types and calculation methods on TMB as well as its cut-off value for predicting immunotherapy efficacy are still need to be further investigated. Methods: 4140 tumor samples were performed with targeted panel sequencing or whole exome sequencing (WES) in different platforms such as illumina and MGI. Public sequencing data from 3680 samples which contained targeted panel sequencing, WES and whole genome sequencing were obtained. The impact of different sequencing platforms, sequencing methods and calculation methods on the calculation of TMB were assessed. Further, targeted panel sequencing data from 71 sample of lung cancer patients treated with ICIs were used to determine the best cut-off value of TMB for predicting immunotherapy response. Results: TMB values calculated by different platforms and different sequencing methods were similar and there was no significant difference. The distribution of TMB at different sequencing depths and tumor purity were analyzed. We found that there was no significant difference in the distribution of TMB when the sequencing depth was greater than 500´, the HE purity was greater than 0.1 or NGS purity was greater than 0.3. In addition, the correlation of TMB calculated from single-sample and paired-sample is 0.95. Further, the optimal cut-off value of TMB in lung cancer treated with ICIs was determined to be 8 through ROC curve analysis, and patients with TMB ≥ 8 had better outcomes than patients with TMB < 8. Conclusions: This study systematically analyzed the factors which influenced the TMB calculation, and verifies the feasibility of TMB calculation from single-sample. More importantly, the cut-off value of TMB for predicting immunotherapy efficacy in lung cancer was defined as 8 in East Asian populations, which can help in clinical decision-making.

The Length of Telomeres and the Baseline Level of Cytogenetic Damage in Leukocytes of Lung Cancer Patients

Despite the great efforts of basic and clinical research on lung cancer (LC), the prevention and treatment of this type of cancer show still far from satisfactory indicators. The complex mechanisms of the LC biology are already recognized, but there is a significant gap in the knowledge about the interaction of key biomarkers in the etiology and progression of this disease. The present work is aimed at studying the relationship between the telomere length (TL) and frequencies of chromosomal aberrations (CA) and micronuclei (MN) in leukocytes of primary lung cancer patients. In 67 men with lung cancer and 77 control donors (men), the baseline frequencies of CA and MN were determined in blood leukocytes, and TL was also studied. As a result, a significant increase in TL was found in lung cancer patients compared with control donors (25.86 ± 2.13 versus 15.29 ± 1.22, respectively, p = 0.00001). In leukocytes of LC patients, a significant increase in the baseline level of structural aberrations of chromosomes, as well as micronuclei containing centromeres, was noted. Only in the sample of lung cancer patients were direct correlations of TL with the frequency of chromosomal type aberrations and with the frequency of paired fragments revealed. In the same sample, significant inverse correlations of TL with the frequency of binucleated leukocytes containing nuclear protrusions and with the frequency of cells entering apoptosis were recorded. The study first showed that an increase in TL in lung cancer patients is associated with structural chromosomal damages, but not with the incidence of aneuploidies.

Patient-reported distress as an early warning sign of unmet palliative care needs and increased healthcare utilization in patients with advanced cancer

Cancer patients' sources of distress are often unaddressed, and patient-reported distress data could be utilized to identify those with unmet and impending care needs. We explored the association between moderate/severe distress and healthcare utilization in a large sample of non-small cell lung cancer (NSCLC) and non-colorectal gastrointestinal cancer patients. Adult patients treated between July 2013 and March 2019. Data from the NCCN Distress Thermometer (DT) and the accompanying "Problem List" were extracted from the EHR. A DT score of ≥ 4 indicates "actionable distress." Statistical analysis was performed using descriptive analysis for patient characteristics, clinical outcomes, and sources of distress. Generalized linear mixed models were fit to determine the relationship between distress and healthcare utilization (hospitalization, emergency department (ED) visit, or both). The ten most frequently reported problems were from the Physical and Emotional domains of the Problem List. Distress was mostly related to physical symptoms (pain, fatigue) and emotional issues (worry, fears, sadness, nervousness). Patients with actionable distress generally reported more problems across all their visits. Actionable distress was associated with higher odds of the composite outcome measure of hospitalization or visiting the ED, within both the next 3months (OR = 1.37; 95% CI = 1.19, 1.58; p < 0.001) and 6months (OR = 1.19; 95% CI = 1.03, 1.37; p = 0.019). Patients with significant distress had marked utilization of ED and inpatient services. DT scores are a source of untapped data in the EHR that can highlight patients in need of intervention, including palliative care and cancer support services.

Frequency of ALK gene rearrangement and its association with survival rate among Upper Egypt Non-Small cell lung cancer patients

Background: Anaplastic Lymphoma Kinase(ALK)gene rearrangement shows ethnic variations worldwide. There isn’t a population-based study measuring its prevalence among the Egyptian population till now. Aim: To measure ALK gene rearrangement prevalence correlated with survival rates among a sample of Upper Egypt Non-Small Cell Lung Cancer (NSCLC) patients. Patients and Methods: The study included twenty-six NSCLC patients. 21 of them were males and the rest were females, the enrolled patients had a median age of 60 years. 8 presented with pleural effusion, while 4 showed brain metastases, and 10 had liver metastases. Most of the cases were given a diagnosis with adenocarcinoma, squamous cell carcinoma (14, 6 cases, respectively), and the rest were given a diagnosis with undifferentiated carcinoma. Fluorescence Insitu Hybridization (FISH) technique was used for detection of rearranged ALK gene from FFEP Tissue Sections. Vysis ALK Break Apart FISH Probe Kit was used, it’s composed of two probes green-labeled one to bind to the 5′ end of the ALK gene, and another orange labeled one to bind to the 3′ end. Tumor cells with 15 % or more separate green 5′ and red 3′ signals or isolated red 3′ signals were considered positive for the rearranged ALK gene, while cells with yellowish signals (representing overlapped signals between green and red probes) were considered negative for ALK gene rearrangement. A fluorescence microscope supplied with a Leica CCD camera was used to detect clinicopathological characteristics of rearranged ALK gene, image processing was done using an imaging system and software. Results: Patients were followed up for 63 months, 15 of them were positive for the rearranged ALK gene. All patients were treated with chemotherapy and they had different objective response rates (ORR), ALK+ve cohort 73.3% (PR:3, SD:8), ALK–ve cohort 100% (PR:6, SD:5). The overall survival rate (OSR) was 51,6%, and two- year progression-free survival rate (PFSR) was 68,8%. Univariate analysis was done between ALK+ve / ALK–ve for different risk groups (age, gender, histological subtype, the site of metastasis, and grade). Patients with adenocarcinoma showed better OSR than those with squamous cell carcinoma, PConclusions: Patients with ALK gene rearrangement are resistant to chemotherapy, so they should be directed for individualized treatment, the prevalence of ALK+ve patients could be more than expected among the Egyptian population. further confirmation is required through multiple center population-based studies. Policymakers are invited for validating central laboratory, they are also recommended to enhance accessibility for diagnostic facilities and services, and adopting inhibitors of tyrosine kinase (TKI) as a new effective treatment strategy for NSCLC cases.

Sleep and quality of life in lung cancer patients and survivors.

Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population. The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting. Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information. Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL. Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors. Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

Estimated annual prevalence, medical service utilization and direct costs of lung cancer in urban China.

BackgroundEvidence‐based policy making for delivering affordable lung cancer care relies on the breadth, depth and quality of knowledge of its treatment costs. This study estimates the annual prevalence, medical service utilization and direct treatment costs of lung cancer in urban China.Materials and MethodsUsing claim data from China's urban basic medical insurance between 2013 and 2016, we constructed a nationally representative sample of lung cancer patients in urban China. Weighted descriptive analyses, Poisson regressions and generalized linear modelling were used to analyse lung cancer medical service utilization and costs and their associations with patient characteristics.ResultsIn urban China, the annual prevalence of lung cancer was 87.65/100000, with nearly 0.65% of total health expenditures of urban residents spent on lung cancer treatments. Weighted average annual total medical costs of lung cancer was RMB33.78 (US$5.36) thousand, with annual out‐of‐pocket costs of RMB10.26 (US$1.63) thousand. The average yearly number of lung cancer‐related outpatient visits was 2.42 and inpatient admissions was 2.07, with an average cost of RMB0.75 (US$0.12) thousand for outpatients and RMB 15.67 (US$2.49) thousand for inpatients. Inpatient expenses were the major component (95%) of lung cancer medical costs, with roughly 67% of inpatient services occurring in high‐level tertiary hospitals. Medical care utilization and direct medical costs were associated with sex, age and insurance status. Western medicine costs were the major contributor (39.4%) to average lung cancer‐related medical costs.ConclusionLung cancer imposed a significant economic burden on China's health system and a financial cost on lung cancer sufferers and their families. Specific policies are required to efficiently allocate health resources, contain health expenditure and decrease the individual financial burden of lung cancer.

Gender effects on quality of life and symptom burden in patients with lung cancer: results from a prospective, cross-cultural, multi-center study.

BackgroundLung cancer causes impairment of health-related quality of life (QoL), but little is known about gender aspects in QoL and symptom burden of lung cancer patients. The aim of this study was to investigate gender differences in QoL as assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the updated lung cancer module.MethodsIn a prospective, international, cross-cultural, multicenter study that was undertaken to update the lung cancer-specific module EORTC QLQ-LC13, patients filled in the core questionnaire EORTC QLQ-C30 and the updated lung cancer module. Gender differences were calculated for all QoL scores using ANCOVAs that controlled for known and suspected confounders. Comparisons with historic data were drawn.ResultsA total of 200 patients (82 female and 118 male, median age 65 years) were recruited. With the exception of coughing (estimated marginal means: women 33.86 and men 43.52, P=0.022) and diarrhea (estimated marginal means: women 26.01 and men 17.93, P=0.038) there were no significant QoL gender differences. Fatigue was the most pronounced symptom in both, men and women, outpacing typical respiratory symptoms. Quite generally, our sample of lung cancer patients showed considerably worse QoL in all scores when compared to EORTC reference data (lung cancer and combined cancer diagnoses, mean differences up to 13.70 and 21.54 score points, respectively) and to a German norm reference sample (up to 35.37 score points).ConclusionsThis study adds to the literature in showing that the typical QoL gender difference effect (women doing worse than men) may not be generalizable across all patient samples.

Approach for Compensation System of Asbestos-Related Lung Cancer

Abstract Background The health hazards of asbestos have been globally recognized, especially those among industrial workers with long-term exposure. Lung cancer is one such asbestos-related disease. It occurs not only among workers but also among residents with environmental exposure to asbestos. Patients with work-related exposure can receive occupational compensation, and patients with non-occupational exposure are supported by a separate compensation system in Japan. However, the latter is not well-known among clinicians, and a substantial number of patients may have been left out. We need an effective way to find patients eligible to receive benefits by better understanding the clinical conditions that characterize patients with asbestos-related lung cancer. Methods We conducted two types of research: 1. Comparison of clinical characteristics between compensation system recipients (N = 65) and general lung cancer patients diagnosed in 2015, using Japan’s National Database of Hospital-Based Cancer Registry. 2. Estimation of the frequency of pleural plaques among lung cancer patients by double-checking CT scan images of a random sample of lung cancer patients obtained from the HBCR national database (N = 3585). Results Patients with squamous cell carcinoma are twice as likely asbestos-induced as patients with other histology overall after adjusting for age, sex and cancer stages, but not smoking status and history. As many as 20% of the CT images were read inconsistently between two radiologists or respiratory disease doctors and we could not obtain the accurate rate of candidacy for the compensation system. Conclusions We require more accurate information about pathological characteristics by controlling for smoking status and history among compensation recipients. For radiologic interpretation, more effective education is needed for the radiologists and respiratory disease doctors who treat lung cancer patients. Key messages Specific information about asbestos-related lung cancer would lead clinicians to correctly identify asbestos-related lung cancer. Educational system for clinicians would help patients to receive the benefit of compensation.

Akciğer kanseri hastalarında dolaşımdaki tümör hücrelerini nasıl tespit ederiz? akım sitometrisi ile yapılan kısa bir çalışma

Circulating tumor cells (CTCs) play a crucial role in the metastatic spread of carcinoma. Therefore, CTC has been interest of a subject in the past few decades in terms of prognosis and response to the therapy in several cancer diseases. Recent improvements in technical approaches maintain to identify CTCs from whole blood have demonstrated the potential value of CTC detection as a liquid biopsy especially in those tumors where tissue accessibility is often challenging as in lung cancer. Lung cancer is the most common cause of death from cancer worldwide in both men and women which is commonly metastasize before it is diagnosed. The aim of this study is to enumerate of CTCs in peripheral blood sample (7.5 mL) of lung cancer patients by flow cytometry. Our modified method which consists of enrichment and detection steps get involved in 9 patients with lung cancer and 9 healthy volunteers. We performed a density-based ficoll gradient centrifugation and a immunomagnetic separation technique (CD45 negative selection) for the enrichment step. Next, multi-parameter flow cytometry based on the expression of anti-epithelial cell adhesion molecule and cytokeratins was used to detect circulating tumor cells among enriched cells. According to our results, circulating tumor cells were not detected on healthy volunteers but circulating tumor cells were found in all of patients with lung cancer (Z=3.823; p&amp;lt;0.001). We demonstrate that circulating tumor cells were detectable in peripheral blood sample of lung cancer patients by our modified method.

Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta-analysis.

To assess the effects of breathing exercises on postoperative pulmonary complications (PPCs), pulmonary function, 6-min walk distance (6MWD) and the length of hospital stay (LOS) in lung cancer patients undergoing lung surgery. Lung cancer patients undergoing lung resection have poor pulmonary function and multiple PPCs. Breathing exercises may improve these symptoms. Systematic literature review and meta-analysis were conducted. All entries to the following databases were searched up until 20 December 2017: PubMed, EMBASE Ovid, the Cochrane Central Register of Randomized Controlled Trials, Web of Science, Wanfang, Weipu and Chinese National Knowledge Infrastructure databases. Only randomised controlled trials (RCTs) were included in the analysis. A total of sixteen articles including nine articles in Chinese language and seven articles in English met the inclusion criteria. Breathing exercises decreased PPCs, and in addition, the incidence of pneumonia and atelectasis in the postoperative subgroup was reduced. Predicted forced expiratory volume in 1s (predicted FEV1 %), predicted forced vital capacity (predicted FVC%), FVC and FEV1 /FVC ratio had improved after breathing exercises, but the changes in FEV1 were not statistically significant. Furthermore, the LOS was significantly decreased, but no improvements were found in 6MWD. The results showed that breathing exercises could improve lung function, decrease the incidence of PPCs and LOS in a sample of lung cancer patients undergoing pulmonary surgery. The analysis suggests that breathing exercises should be considered as a respiratory rehabilitation programme for lung cancer patients undergoing lung surgery in clinical practice.

Effects of Behavioral Activation on the Quality of Life and Emotional State of Lung Cancer and Breast Cancer Patients During Chemotherapy Treatment.

Research suggests that the progressive abandonment of activities in cancer patients are related to depression and worse quality of life. Behavioral activation (BA) encourages subjects to activate their sources of reinforcement and modify the avoidance responses. This study assesses the effectiveness of BA in improving quality of life and preventing emotional disorders during chemotherapy treatment. One sample of lung cancer patients and another of breast cancer patients were randomized into a BA experimental group (E.G.lung/4sess.n = 50; E.G.breast/6sess.n = 33) and a control group (C.G.lung/4sess.n = 40; C.G.breast/6sess.n = 35), respectively. In each session and in follow-ups (3/6/9 months), all participants completed different assessment scales. The results converge to show the effectiveness of BA, encouraging cancer patients to maintain rewarding activities which can activate their sources of day-to-day reinforcement and modify their experience avoidance patterns. BA appears to be a practical intervention which may improve social and role functioning and the emotional state of cancer patients during chemotherapy treatment.

Posttraumatic Symptoms, Quality of Life, and Survival among Lung Cancer Patients

This longitudinal study characterized psychological adjustment in a sample of lung cancer patients by examining the occurrence of posttraumatic stress and growth and their relationships with mental and physical health quality of life and survival over time. Two waves of consecutive cohort samples, totaling 115 participants diagnosed with lung cancer, were identified from outpatient oncology clinics. Of these, 93 consented and completed the first of three assessments, and 57 completed the study. Prevalence of posttraumatic stress symptoms (PTSD Checklist) and posttraumatic growth (Posttraumatic Growth Inventory) were assessed and used to predict physical and mental health components of quality of life (Short Form 36) and survival. Patients reported both negative and positive psychological sequelae, with prevalence of estimated PTSD ranging from 5-16% at each assessment as determined by symptom and cut-off methods. Posttraumatic stress and growth were positively related, but were differentially associated with outcomes. More posttraumatic stress predicted lower mental health quality of life, whereas more posttraumatic growth predicted better physical health quality of life and longer survival. These relationships persisted after accounting for disease variables and attrition due to death or illness. These findings highlight the importance of using longitudinal designs to identify relationships between stress and resilience factors in predicting outcomes.

Preparation for the end of life and life completion during late-stage lung cancer: An exploratory analysis.

Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions. We employed an exploratory cross-sectional design to examine psychosocial and existential concerns among a purposive sample (N=30) of advanced lung cancer patients using the "end-of-life preparation" and "life completion" subscales of the Quality of Life at the End of Life (QUAL-E) questionnaire. Nonparametric methods were employed to analyze preparation, completion, global quality of life (QoL), and the associations among depressive symptoms, preparation, completion, and global QoL. Higher scores on life completion were associated with better global QoL, and with items related to transcendence, communicative acts, and interpersonal relationships demonstrating important contributions. The perception of being a future burden on family members was the greatest concern within the preparation domain. Depressive symptoms were not associated with preparation, completion, or global QoL. Psychosocial and existential issues contribute to QoL at the EoL among older adults with late-stage lung cancer during cancer-directed therapy, concurrent care, and hospice. The role of preparation, especially self-perceived burden, merits further research early on in the oncological setting. The preparation and life completion subscales of the QUAL-E are feasible clinical tools for facilitating dyadic communication about sensitive topics in the palliative care setting.

Temporal patterns of care and outcomes of non-small cell lung cancer patients in the United States diagnosed in 1996, 2005, and 2010

IntroductionLung cancer remains a common and deadly cancer in the United States. This study evaluated factors associated with stage-specific cancer therapy and survival focusing on temporal trends and sociodemographic disparities. MethodsA random sample (n=3,318) of non-small cell lung cancer (NSCLC) patients diagnosed in 1996, 2005 and 2010, and reported to the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program was analyzed. Logistic regression was utilized to identify factors associated with receipt of surgery among stage I/II patients and chemotherapy among stage IIIB/IV patients. Cox proportional hazard regression was utilized to assess factors associated with all-cause mortality, stratified by stage. ResultsSurgery among stage I/II patients decreased non-significantly overtime (1996: 78.8%; 2010: 68.5%; p=0.18), whereas receipt of chemotherapy among stage IIIB/IV patients increased significantly overtime (1996: 36.1%; 2010: 51.2%; p<0.01). Receipt of surgery (70–79 and ≥80 vs. <70: Odds Ratio(OR):0.31; 95% Confidence Interval (CI): 0.16–0.63 and OR:0.04; 95% CI: 0.02–0.10, respectively) and chemotherapy (≥80 vs. <70: OR: 0.26; 95% CI:0.15–0.45) was less likely among older patients. Median survival improved non-significantly among stage I/II patients from 51 to 64 months (p=0.75) and significantly among IIIB/IV patients from 4 to 5 months (p<0.01). ConclusionTreatment disparities were observed in both stage groups, notably among older patients. Among stage I/II patients, survival did not change significantly possibly due to stable surgery utilization. Among stage IIIB/IV patients, although the use of chemotherapy increased and survival improved, the one-month increase in median survival highlights the need for addition research.

A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project

We provide a systematic review to support the European Palliative Care Research Collaboration development of clinical guidelines for cancer patients suffering from cachexia. CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov, and a selection of cancer journals have been searched up until 15 April 2016. The systematic literature research yielded 4214 publications with 21 of these included in the final evaluation. Regarding minerals, our search identified only one study examining the use of magnesium with no effect on weight loss. As far as vitamins are concerned, vitamin E in combination with omega‐3 fatty acids displayed an effect on survival in a single study, vitamin D showed improvement of muscle weakness in prostate cancer patients, and vitamin C supplementation led to an improvement of various quality of life aspects in a sample with a variety of cancer diagnoses. For proteins, a combination therapy of β‐hydroxy‐β‐methylbutyrate (HMB), arginine, and glutamine showed an increase in lean body mass after 4 weeks in a study of advanced solid tumour patients, whereas the same combination did not show a benefit on lean body mass in a large sample of advanced lung and other cancer patients after 8 weeks. L‐carnitine led to an increase of body mass index and an increase in overall survival in advanced pancreatic cancer patients. Adverse effects of food supplementation were rare and showed mild intensity. There is not enough solid evidence for the use of minerals, vitamins, proteins, or other supplements in cancer. No serious adverse effects have been reported with dietary supplementation.