Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The Second ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on management of patients with non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, early stage disease, locally advanced disease and advanced (metastatic) disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on recommendations for pathology and molecular biomarkers in relation to the diagnosis of lung cancer, primarily non-small-cell carcinomas.

Childhood brain tumours: associations with parental occupational exposure to solvents

BACKGROUND

Parental occupational exposures have been associated with childhood brain tumours (CBT), but results are inconsistent. Few studies have studied CBT risk and parental solvent exposure, suggesting a possible association. We examined the association between CBT and parental occupational exposure to solvents in a case-control study.

METHODS

Parents of 306 cases and 950 controls completed detailed occupational histories. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for both maternal and paternal exposure to benzene, other aromatics, aliphatics and chlorinated solvents in key time periods relative to the birth of their child. Adjustments were made for matching variables (child's age, sex and state of residence), best parental education and occupational exposure to diesel exhaust.

RESULTS

An increased risk of CBT was observed with maternal occupational exposures to chlorinated solvents (OR=8.59, 95% CI 0.94-78.9) any time before birth. Paternal exposure to solvents in the year before conception was associated with an increased CBT risk: OR=1.55 (95% CI 0.99-2.43). This increased risk appeared to be mainly attributable to exposure to aromatic solvents: OR=2.72 (95% CI 0.94-7.86) for benzene and OR=1.76 (95% CI 1.10-2.82) for other aromatics.

CONCLUSIONS

Our results indicate that parental occupational exposures to solvents may be related to an increased risk of CBT.

Patients with AIDS-defining cancers are not universally screened for HIV: a 10-year retrospective analysis of HIV-testing practices in a Swiss university hospital

OBJECTIVES

Kaposi's sarcoma (KS), invasive cervical carcinoma (ICC) and non-Hodgkin lymphoma (NHL) have been listed as AIDS-defining cancers (ADCs) by the Centers for Disease Control and Prevention since 1993. Despite this, HIV screening is not universally mentioned in ADC treatment guidelines. We examined screening practices at a tertiary centre serving a population where HIV seroprevalence is 0.4%.

METHODS

Patients with KS, ICC, NHL and Hodgkin lymphoma (HL), treated at Lausanne University Hospital between January 2002 and July 2012, were studied retrospectively. HIV testing was considered part of the oncology work-up if performed between 90 days before and 90 days after the cancer diagnosis date.

RESULTS

A total of 880 patients were examined: 10 with KS, 58 with ICC, 672 with NHL and 140 with HL. HIV testing rates were 100, 11, 60 and 59%, and HIV seroprevalence was 60, 1.7, 3.4 and 5%, respectively. Thirty-seven patients (4.2%) were HIV-positive, of whom eight (22%) were diagnosed at oncology work-up. All newly diagnosed patients had CD4 counts < 200 cells/μL and six (75%) had presented to a physician 12-236 weeks previously with conditions warranting HIV testing.

CONCLUSIONS

In our institution, only patients with KS were universally screened. Screening rates for other cancers ranged from 11 to 60%. HIV seroprevalence was at least fourfold higher than the population average. As HIV-positive status impacts on cancer patient medical management, HIV screening should be included in oncology guidelines. Further, we recommend that opt-out screening should be adopted in all patients with ADCs and HL.

[Postoperative radiation therapy in lung carcinom]

Locally advanced non-small-cell lung carcinoma (NSCLC) is a very heterogeous disease, the role of postoperative radiation therapy (PORT) in pN2 patients with completly resected NSCLC remains controversial. Although an improvment in local control has been described in several studies, the effect on survival has been contradictory or inconclusive. Retrospective evaluation suggest a positive effect of PORT in high risk patients with pN2 disease: RI-resected NSCLC, bulky and multilevel N2. However further evaluation of PORT in prospectively randomized studies in completely resected pN2 NSCLC is needed.

Typical versions of learned swamp sparrow song types are more effective signals than are less typical versions

The learned songs of songbirds often cluster into population-wide types. Here, we test the hypothesis that male and female receivers respond differently to songs depending on how typical of those types they are. We used computational methods to cluster a large sample of swamp sparrow (Melospiza georgiana) songs into types and to estimate the degree to which individual song exemplars are typical of these types. We then played exemplars to male and female receivers. Territorial males responded more aggressively and captive females performed more sexual displays in response to songs that are highly typical than to songs that are less typical. Previous studies have demonstrated that songbirds distinguish song types that are typical for their species, or for their population, from those that are not. Our results show that swamp sparrows also discriminate typical from less typical exemplars within learned song-type categories. In addition, our results suggest that more typical versions of song types function better, at least in male-female communication. This finding is consistent with the hypothesis that syllable type typicality serves as a proxy for the assessment of song learning accuracy.

2nd ESMO Consensus Conference on Lung Cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on first line/second and further lines of treatment in advanced disease.

Public Health England survey of eye lens doses in the UK medical sector

The ICRP has recently recommended that the occupational exposure limit for the lens of the eye be reduced to 20 mSv in a year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv. There has been concern amongst some groups of individuals, particularly interventional cardiologists and radiologists as well as relevant professional bodies, that implementation of these recommendations into UK law will adversely affect working patterns. However, despite a number of informative European studies, there is currently little UK dosimetry data available upon which judgements can effectively be based. In order to address this knowledge gap, Public Health England has carried out a small, targeted survey of UK lens doses to medical staff undertaking procedures likely to involve the highest levels of radiation exposure. Two out of a total of 61 individuals surveyed had projected annual doses which could be close to 20 mSv, measured outside lead glasses. Use of protective equipment was generally good; however, lead glasses were only used by 9 participants. The results of this survey suggest that compliance with the ICRP recommendations is likely to be possible for most individuals in the UK medical sector.

[Striae distensae, colors and mechanobiology]

Striae distensae represent a common skin condition, corresponding to a physiological event particularly developed during adolescence, pregnancy and gain in body weight. In addition, these lesions are induced by the Cushing syndrome or an intense corticotherapy. The viscoelastic properties of the skin are altered and vary according to the severity of striae distensae. Otherwise, the colours of striae distensae vary with time in response to the mechanobiology of blood vessels and melanocytes.

Early training in tackling patient obesity: a systematic review of nurse education

OBJECTIVES

This systematic review aims to identify studies that have assessed educational interventions in undergraduate nurse training regarding obesity, and to investigate the interventions' effectiveness.

BACKGROUND

Obesity is a prominent global issue and nurses have an increased role in weight management with patients. The literature has identified various theory-based behaviour change techniques that successfully assist weight management in patients. Thus, training nurses in obesity-related behaviour change techniques is appropriate in preparing them for their future professional role. However, effectiveness of these educational interventions has not yet been assessed.

METHODS

The Centre for Reviews and Dissemination guidelines informed this systematic review. Four databases were systematically searched and articles were assessed against inclusion criteria. Data extraction and quality appraisal forms were developed and completed to identify salient features within the articles.

RESULTS

Eight studies met inclusion criteria. Only two included both baseline and outcome measures, one of which was a randomised controlled trial. Additionally, only one study included an explicitly identified behaviour change technique. Interventions were delivered through a range of methods, however, quality appraisal indicated that all of the studies had poor methodologies and had high risks of bias.

CONCLUSIONS

Studies in this area of research are sparse and are not methodologically robust. Therefore, it is not possible to identify effective educational interventions for nursing students on weight management.

IMPLICATIONS

More robust research is needed to investigate how nurses can be trained to facilitate weight management. Greater transparency of intervention descriptions, particularly around what behaviour change techniques were taught, would allow for replication and appropriate evaluation. Until then, it is not known if current teaching adequately equips nurses to manage obese and overweight patients.