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Miyamori D, Kamitani T, Yoshida S, Kikuchi Y, Shigenobu Y, Ikeda K, Yamamoto Y, Ito M. Effects of the Coronavirus disease 2019 pandemic on mortality in patients with lung cancer: A multiple mediation analysis in Japan. Int J Cancer 2024; 155:1422-1431. [PMID: 38794791 DOI: 10.1002/ijc.35042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/20/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
COVID-19 pandemic has had a substantial effect on healthcare systems worldwide, including the care of patients with lung cancer. The impact of healthcare disruptions and behavioral changes on lung cancer mortality is unclear. Patients newly diagnosed with lung cancer during the pandemic period 2020-2021 were compared with those diagnosed in the pre-pandemic 2018-2019. The primary outcome was all-cause mortality within 1 year. Cox proportional hazards regression analyses were conducted to estimate the changes in mortality between pandemic and pre-pandemic. Multiple mediation analyses were performed to determine the factors that accounted for the changes in mortality. In total, 5785 patients with lung cancer were included in this study. The overall mortality rate was significantly higher during the pandemic compared with the pre-pandemic (crude hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.05, 1.29). Mediation analyses showed that not receiving tumor-directed treatment, diagnosis at an older age, and decreased diagnosis through cancer screening significantly accounted for 17.5% (95%CI: 4.2, 30.7), 13.9% (95%CI: 0.8, 27.0), and 12.4% (95%CI: 3.0, 21.8) of the increased mortality, respectively. This study revealed a significant increase in mortality risk in patients with lung cancer who have not received tumor-directed treatment or cancer screening, despite potential selection bias for follow-up status. Efforts should be focused on ensuring timely access to healthcare services, optimizing treatment delivery, and addressing the unique challenges faced by patients with lung cancer during the pandemic to mitigate the impact of the pandemic on lung cancer outcomes and provide clinical care to vulnerable populations.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | - Shuhei Yoshida
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuka Kikuchi
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuya Shigenobu
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kotaro Ikeda
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
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Kilic S, Zhao J, Okut H, Jani CT, Radwan A, Dudipala H, Burns L, Tapan U. Disparities in US Lung Cancer Clinical Trial Enrollment. J Racial Ethn Health Disparities 2024; 11:3201-3209. [PMID: 37651069 DOI: 10.1007/s40615-023-01776-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Disparities within clinical trial enrollment are well-documented, reducing the generalizability of results. Although nearly 30 years have passed since Congress passed the NIH Revitalization Act to encourage the participation of minoritized populations in clinical trials, these patients continue to be underrepresented. This study aimed to investigate lung cancer clinical trial enrollment disparities for race/ethnicity, sex, and age. METHODS We queried the National Institutes of Health: US National Library of Medicine database of clinical trials for all US-based lung cancer clinical trials completed between 2004 and 2021 and collected data on race and ethnicity, gender, and age breakdown. This data was compared to Surveillance, Epidemiology, and End Results (SEER) database data. Independent sample t-tests and Kruskal-Wallis's approach were used to analyze the data. RESULTS Of 311 eligible trials with exclusive US enrollment, 136 (44%) reported race and ethnicity breakdown for the patient cohort representing 9869 patients. Hispanic, Non-Hispanic American Indian/Alaska Native, Non-Hispanic Black, and Non-Hispanic Unreported participants were underrepresented (p = 0.001, p = 0.005, p = 0.014, p = 0.002, respectively). Non-Hispanic White participants were overrepresented (p = 0.018). Disparities worsened from 2017 to 2021 for Hispanic patients (p = 0.03). No significant differences were found for sex or age. CONCLUSIONS Disparities for clinical lung cancer trial enrollment have not shown statistically significant improvement since 2004, and representation remains unequal, especially for racial and ethnic minorities.
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Affiliation(s)
- Seyda Kilic
- School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Jenny Zhao
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Hayrettin Okut
- Kansas University School of Medicine, Kansas City, KS, USA
| | - Chinmay T Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - Amr Radwan
- Section of Hematology and Medical Oncology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
| | - Harshitha Dudipala
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Laura Burns
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Umit Tapan
- Section of Hematology and Medical Oncology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA.
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Jiang X, Chen J, Gu FF, Li ZR, Song YS, Long JJ, Zhang SZ, Xu TT, Tang YJ, Gu JY, Fang XM. Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions. World J Clin Cases 2024; 12:3791-3799. [PMID: 38994323 PMCID: PMC11235426 DOI: 10.12998/wjcc.v12.i19.3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence and mortality of lung cancer have increased annually. Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis. Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer. Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years. AIM To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions. METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People's Hospital. The patients were randomly divided into two groups: The CEUS-guided before lesion puncture group (contrast group) and conventional ultrasound-guided group (control group). Analyze the diagnostic efficacy of the puncture biopsy, impact of tumor size, and number of puncture needles and complications were analyzed and compared between the two groups. RESULTS Accurate pathological results were obtained for 92.83% (220/237) of peripheral lung lesions during the first biopsy, with an accuracy rate of 95.8% (113/118) in the contrast group and 89.9% (107/119) in the control group. The difference in the area under the curve (AUC) between the contrast and the control groups was not statistically significant (0.952 vs 0.902, respectively; P > 0.05). However, when the lesion diameter ≥ 5 cm, the diagnostic AUC of the contrast group was higher than that of the control group (0.952 vs 0.902, respectively; P < 0.05). In addition, the average number of puncture needles in the contrast group was lower than that in the control group (2.58 ± 0.53 vs 2.90 ± 0.56, respectively; P < 0.05). CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions, especially for lesions with a diameter ≥ 5 cm. Therefore, CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.
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Affiliation(s)
- Xiao Jiang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Jun Chen
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Fang-Fang Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Zhong-Rong Li
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yu-Shan Song
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Jing-Jing Long
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Shu-Zhen Zhang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ting-Ting Xu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yong-Jun Tang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ji-Ying Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
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Kiruthiga C, Balan DJ, Prasath NH, Manikandakrishnan M, Jafni S, Prabhu NM, Pandian SK, Devi KP. Synergistic induction of apoptosis in lung cancer cells through co-delivery of PLGA phytol/α-bisabolol nanoparticles. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:5131-5144. [PMID: 38240783 DOI: 10.1007/s00210-023-02935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/27/2023] [Indexed: 06/12/2024]
Abstract
This study explored the potential of poly-(lactic-co-glycolic) acid (PLGA) nanoparticles to enhance the effectiveness of anticancer treatments through combination therapy with phytol and α-bisabolol. The encapsulation efficiency of the nanoparticles was investigated, highlighting the role of ionic interactions between the drugs and the polymer. Characterization of PLGA-Phy+Bis nanoparticles was carried out using DLS with zeta potential and HR-TEM for size determination. Spectrophotometric measurements evaluated the encapsulation efficiency, loading efficiency, and in vitro drug release. FTIR analysis assessed the chemical interactions between PLGA and the drug actives, ensuring nanoparticle stability. GC-MS was employed to analyze the chemical composition of drug-loaded PLGA nanocarriers. Cytotoxicity was evaluated via the MTT assay, while Annexin V-FITC/PI staining and western blot analysis confirmed apoptotic cell death. Additionally, toxicity tests were performed on L-132 cells and in vivo zebrafish embryos. The study demonstrates high encapsulation efficiency of PLGA-Phy+Bis nanoparticles, which exhibit monodispersity and sizes of 189.3±5nm (DLS) and 268±54 nm (HR-TEM). Spectrophotometric analysis confirmed efficient drug encapsulation and release control. FTIR analysis revealed nanoparticle structural stability without chemical interactions. MTT assay results demonstrated the promising anticancer potential of all the three nanoparticle types (PLGA-Phy, PLGA-Bis, and PLGA-Phy+Bis) against lung cancer cells. Apoptosis was confirmed through Annexin V-FITC/PI staining and western blot analysis, which also revealed changes in Bax and Bcl-2 protein expression. Furthermore, the nanoparticles exhibited non-toxicity in L-132 cells and zebrafish embryo toxicity tests. PLGA-Phy+Bis nanoparticles exhibited efficient encapsulation, controlled release, and low toxicity. Apoptosis induction in A549 cells and non-toxicity in healthy cells highlight their clinical potential.
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Affiliation(s)
| | | | - Nagaiah Hari Prasath
- Department of Biotechnology, Alagappa University, Karaikudi, 630 003, Tamil Nadu, India
| | - Muthushanmugam Manikandakrishnan
- Disease Control and Prevention lab, Department of Animal Health and Management, Alagappa University, Karaikudi, 630 003, Tamil Nadu, India
| | - Sakthivel Jafni
- Department of Biotechnology, Alagappa University, Karaikudi, 630 003, Tamil Nadu, India
| | - Narayanasamy Marimuthu Prabhu
- Disease Control and Prevention lab, Department of Animal Health and Management, Alagappa University, Karaikudi, 630 003, Tamil Nadu, India
| | | | - Kasi Pandima Devi
- Department of Biotechnology, Alagappa University, Karaikudi, 630 003, Tamil Nadu, India.
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Cai J, Li Y, Yang F. Caucasian validation of downstaging from IIB to IIA in T1N1M0 patients within the 9th edition of the non-small cell lung cancer tumor-node-metastasis staging. Cancer Med 2024; 13:e70018. [PMID: 39045904 PMCID: PMC11267448 DOI: 10.1002/cam4.70018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The 9th edition of the lung cancer tumor-node-metastasis (TNM) staging introduced adjustments, including the reclassification of T1N1M0 patients from stage IIB to IIA. This update used data mostly from Asian populations. However, the applicability of these adjustments to Caucasian patients remains uncertain. METHODS Stage II non-small cell lung cancer (NSCLC) patients from the Surveillance, Epidemiology, and End Results (SEER) database were included. Kaplan-Meier analysis with log-rank testing compared overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) balanced baseline characteristics. The least absolute shrinkage and selection operator (LASSO)-based Cox analyses identified prognostic factors. RESULTS Among 10,470 eligible stage II NSCLC patients (median age: 69 years; male: 53.1%), there were 2736 in stage IIA, 2112 in IIA New, and 5622 in IIB groups. Before PSM, survival outcomes of stage IIA New patients were similar to those of stage IIA patients but better than those of stage IIB. After PSM, stage IIA New and IIB patients showed similar survival rates (OS, p = 0.276; CSS, p = 0.565). Conversely, stage IIA New patients had worse outcomes than stage IIA patients (OS, p < 0.001; CSS, p = 0.005). LASSO-based Cox analyses confirmed stage IIA New patients had inferior prognosis compared to stage IIA patients (OS HR: 1 vs. 1.325, p < 0.001; CSS HR: 1 vs. 1.327, p < 0.001). CONCLUSIONS The downstaging of T1N1M0 patients from stage IIB to IIA in the 9th edition TNM staging remains unverified in Caucasians. Caution is warranted in assessing the staging and prognosis of these individuals. Further validation of our findings is necessary.
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Affiliation(s)
- Jingsheng Cai
- Thoracic Oncology Institute and Research Unit of Intelligence Diagnosis and Treatment in Early Non‐small Cell Lung CancerPeking University People's HospitalBeijingPeople's Republic of China
- Department of Thoracic SurgeryPeking University People's HospitalBeijingPeople's Republic of China
- Institute of Advanced Clinical MedicinePeking UniversityBeijingPeople's Republic of China
| | - Yun Li
- Thoracic Oncology Institute and Research Unit of Intelligence Diagnosis and Treatment in Early Non‐small Cell Lung CancerPeking University People's HospitalBeijingPeople's Republic of China
- Department of Thoracic SurgeryPeking University People's HospitalBeijingPeople's Republic of China
| | - Feng Yang
- Thoracic Oncology Institute and Research Unit of Intelligence Diagnosis and Treatment in Early Non‐small Cell Lung CancerPeking University People's HospitalBeijingPeople's Republic of China
- Department of Thoracic SurgeryPeking University People's HospitalBeijingPeople's Republic of China
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Tieu V, MacDowell S, Tibi S, Ventayen B, Agarwal M. Identifying Populations at Risk for Lung Cancer Mortality from the National Health and Nutrition Examination Survey (2001-2018) Using the 2021 USPSTF Screening Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:781. [PMID: 38929027 PMCID: PMC11203664 DOI: 10.3390/ijerph21060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Lung cancer (LC) is the leading cause of cancer mortality in the United States. To combat this predicament, early screening and critically assessing its risk factors remain crucial. The aim of this study was to identify the value of specific factors from the National Health and Nutrition Examination Survey (NHANES) from 2001-2018, as they relate to lung cancer mortality in the US Preventive Services Task Force (USPSTF)-eligible population. A total of 3545 adults who met USPSTF criteria were extracted from 81,595 NHANES participants. The LC Death Risk Assessment Tool was used to calculate the number of deaths per 1000 individuals. The Mann-Whitney U test and one-way ANOVA determined the statistical significance of the factors involved in LC mortality. Male sex, African and Hispanic ethnicity, lower education attainment, and secondhand exposure to cigarette smoke correlated with an increased risk of LC mortality. Additionally, the factor of emotional support from NHANES data was analyzed and did not show any benefit to reducing risk. By identifying individuals at high-risk, preventative measures can be maximized to produce the best possible outcome.
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Mu H, Yang X, Li Y, Zhou B, Liu L, Zhang M, Wang Q, Chen Q, Yan L, Sun W, Pan G. Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment. Front Oncol 2024; 14:1382197. [PMID: 38863625 PMCID: PMC11165022 DOI: 10.3389/fonc.2024.1382197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
Background No studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival. Methods First course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson's chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment. Results Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90). Conclusion The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.
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Affiliation(s)
- Huijuan Mu
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Xing Yang
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Yanxia Li
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Bingzheng Zhou
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
- Department of Orthopaedic Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Liu
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Minmin Zhang
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Qihao Wang
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Qian Chen
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Lingjun Yan
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Wei Sun
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
| | - Guowei Pan
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, China
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Rodriguez GM, Popat R, Rosas LG, Patel MI. Racial and Ethnic Disparities in Intensity of Care at the End of Life for Patients With Lung Cancer: A 13-Year Population-Based Study. J Clin Oncol 2024; 42:1646-1654. [PMID: 38478794 PMCID: PMC11095875 DOI: 10.1200/jco.23.01045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 05/09/2024] Open
Abstract
PURPOSE Lung cancer is the leading cause of cancer death in the United States. Disparities in lung cancer mortality among racial and ethnic minorities are well documented. Less is known as to whether racial and ethnic minority patients with lung cancer experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic White (NHW) patients. METHODS We conducted a population-based analysis of patients 18 years and older with a lung cancer diagnosis who died between 2005 and 2018 using the California Cancer Registry linked to patient discharge data abstracts. Our primary outcome was intensity of care in the last 14 days before death (defined as any hospital admission or emergency department [ED] visit, intensive care unit [ICU] admission, intubation, cardiopulmonary resuscitation [CPR], hemodialysis, and death in an acute care setting). We used multivariable logistic regression models to evaluate associations between race and ethnicity and intensity of EOL care. RESULTS Among 207,429 patients with lung cancer who died from 2005 to 2018, the median age was 74 years (range, 18-107) and 106,821 (51%) were male, 146,872 (70.8%) were NHW, 1,045 (0.5%) were American Indian, 21,697 (10.5%) were Asian Pacific Islander (API), 15,490 (7.5%) were Black, and 22,325 (10.8%) were Hispanic. Compared with NHW patients, in the last 14 days before death, API, Black, and Hispanic patients had greater odds of a hospital admission, an ICU admission, intubation, CPR, and hemodialysis and greater odds of a hospital or ED death. CONCLUSION Compared with NHW patients, API, Black, and Hispanic patients who died with lung cancer experienced higher intensity of EOL care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the EOL.
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Affiliation(s)
- Gladys M. Rodriguez
- Department of Medicine, Northwestern University Feinberg School of Medicine and the Comprehensive Cancer Center, Chicago, IL
| | - Rita Popat
- Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford, CA
| | - Lisa G. Rosas
- Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford, CA
| | - Manali I. Patel
- Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Ohta R, Sano C. Disparity of the Treatment of Unresectable Non-small Cell Lung Cancer Regarding Chemotherapy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e60635. [PMID: 38899245 PMCID: PMC11185987 DOI: 10.7759/cureus.60635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
This study investigates disparities in chemotherapy treatment for unresectable non-small cell lung cancer (NSCLC) between urban and rural populations. Despite advancements in NSCLC treatments enhancing survival, significant inequities persist, notably in rural areas where access to care is often limited, resulting in poorer outcomes. Through a systematic review and meta-analysis, we analyzed data from selected studies that compare chemotherapy access and usage between these populations from 2010 to 2024. Our findings indicate that rural patients are consistently less likely to receive advanced chemotherapy treatments than urban counterparts, with a pooled odds ratio of 0.91 (95% confidence interval (CI): 0.83-1.00), suggesting a marginal but noticeable disparity. This highlights a crucial gap in healthcare provision, underscoring the need for policy interventions and improved healthcare practices to ensure equitable treatment access. This research calls for further investigation into socioeconomic and cultural factors contributing to these disparities to inform targeted improvement strategies.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Gao L, Dhilipkannah P, Holden VK, Deepak J, Sachdeva A, Todd NW, Stass SA, Jiang F. Differential Non-Coding RNA Profiles for Lung Cancer Early Detection in African and White Americans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.27.24304977. [PMID: 38585975 PMCID: PMC10996737 DOI: 10.1101/2024.03.27.24304977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction Lung cancer leads in cancer-related deaths. Disparities are observed in lung cancer rates, with African Americans (AAs) experiencing disproportionately higher incidence and mortality compared to other ethnic groups. Non-coding RNAs (ncRNAs) play crucial roles in lung tumorigenesis. Our objective was to identify ncRNA biomarkers associated with the racial disparity in lung cancer. Methods Using droplet digital PCR, we examined 93 lung-cancer-associated ncRNAs in the plasma and sputum samples from AA and White American (WA) participants, which included 118 patients and 92 cancer-free smokers. Subsequently, we validated our results with a separate cohort comprising 56 cases and 72 controls. Results In the AA population, plasma showed differential expression of ten ncRNAs, while sputum revealed four ncRNAs when comparing lung cancer patients to the control group. In the WA population, the plasma displayed eleven ncRNAs, and the sputum had five ncRNAs showing differential expression between the lung cancer patients and the control group. For AAs, we identified a three-ncRNA panel (plasma miRs-147b, 324-3p, 422a) diagnosing lung cancer in AAs with 86% sensitivity and 89% specificity. For WAs, a four-ncRNA panel was developed, comprising sputum miR-34a-5p and plasma miRs-103-3p, 126-3p, 205-5p, achieving 88% sensitivity and 87% specificity. These panels remained effective across different stages and histological types of lung tumors and were validated in the independent cohort. Conclusions The ethnicity-related ncRNA signatures have promise as biomarkers to address the racial disparity in lung cancer.
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Park JH, Kim SJ, Medina M, Prochnow T, Min K, Chang J. Are comorbidities associated with differences in healthcare charges among lung cancer patients in US hospitals? Focusing on variances by patient and socioeconomic factors. Chronic Illn 2024:17423953241241759. [PMID: 38532693 DOI: 10.1177/17423953241241759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The clinical aspects of lung cancer patients are well-studied. However, healthcare charge patterns have yet to be explored through a large-scale representative population-based sample investigating differences by socioeconomic factors and comorbidities. AIM To identify how comorbidities associated with healthcare charges among lung cancer patients. METHODS We examined the characteristics of the patient sample and the association between comorbidity status (diabetes, hypertension, or both) and healthcare charge. Multivariate survey linear regression models were used to estimate the association. We also investigated sub-group association through various patient and socioeconomic factors. RESULTS Of 212,745 lung cancer patients, 68.5% had diabetes and/or hypertension. Hospital charges were higher in the population with comorbidities. The results showed that lung cancer patients with comorbidities had 9.4%, 5.1%, and 12.0% (with diabetes, hypertension, and both, respectively) higher hospital charges than those without comorbidities. In sub-group analysis, Black patients also showed a similar trend across socioeconomic (i.e. household income and primary payer) and racial (i.e. White, Black, Hispanic, and Asian/Pacific Islander) factors. DISCUSSION Black patients may be significantly financially burdened because of the prevalence of comorbidities and low-income status. More work is required to ensure healthcare equality and promote access to care for the uninsured, low-income, and minority populations because comorbidities common in these populations can create more significant financial barriers.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- Department of Pharmacy Practice, School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Tyler Prochnow
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Kisuk Min
- Department of Kinesiology, College of Health Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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12
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Gurney J, Davies A, Stanley J, Cameron L, Costello S, Dawkins P, Henare K, Jackson CG, Lawrenson R, Whitehead J, Koea J. Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context. JCO Glob Oncol 2024; 10:e2300258. [PMID: 38301179 PMCID: PMC10846779 DOI: 10.1200/go.23.00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis. METHODS We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. RESULTS Māori patients with lung cancer appeared less likely to access surgery than European patients (Māori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Māori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Māori patients compared with European patients, this difference was small and requires further investigation. CONCLUSION Our observation of differences in surgery rates between Māori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Māori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.
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Affiliation(s)
| | - Anna Davies
- University of Otago, Wellington, New Zealand
| | | | - Laird Cameron
- Te Whatu Ora—Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Paul Dawkins
- Te Whatu Ora—Counties Manukau, Auckland, New Zealand
| | | | | | - Ross Lawrenson
- Population and Public Health, Te Whatu Ora—Waikato, Hamilton, New Zealand
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13
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Brock BA, Mir H, Flenaugh EL, Oprea-Ilies G, Singh R, Singh S. Social and Biological Determinants in Lung Cancer Disparity. Cancers (Basel) 2024; 16:612. [PMID: 38339362 PMCID: PMC10854636 DOI: 10.3390/cancers16030612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes.
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Affiliation(s)
- Briana A. Brock
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Hina Mir
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Eric L. Flenaugh
- Division of Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Gabriela Oprea-Ilies
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Shailesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
- Cell and Molecular Biology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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14
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Robinson-Oghogho JN, Alcaraz KI, Thorpe RJ. Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States. Cancer Control 2024; 31:10732748241248363. [PMID: 38698674 PMCID: PMC11067682 DOI: 10.1177/10732748241248363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. METHODS We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. RESULTS Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. CONCLUSION Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.
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Affiliation(s)
- Joelle N. Robinson-Oghogho
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kassandra I. Alcaraz
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Roland J. Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Griesemer I, Gottfredson NC, Thatcher K, Rini C, Birken SA, Kothari A, John R, Guerrab F, Clodfelter T, Lightfoot AF. Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes. Health Promot Pract 2023:15248399231213042. [PMID: 38050901 DOI: 10.1177/15248399231213042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. METHOD We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. RESULTS Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. DISCUSSION The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.
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Affiliation(s)
- Ida Griesemer
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Kari Thatcher
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aneri Kothari
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- People's Action Institute, Washington, DC, USA
| | | | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Alnajar A, Razi SS, Kodia K, Villamizar N, Nguyen DM. The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non-small cell lung cancer. JTCVS OPEN 2023; 16:888-906. [PMID: 38204620 PMCID: PMC10775054 DOI: 10.1016/j.xjon.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 01/12/2024]
Abstract
Objectives Textbook oncological outcome (TOO) is a composite metric for surgical outcomes, including non-small cell lung cancer (NSCLC). We hypothesized that social determinants of health (SDH) can affect both the attainment of TOO and the overall survival (OS) in surgically resected NSCLC patients with pathological nodal disease. Methods We queried the National Cancer Database (2010-2017) for preoperative therapy-naïve lobectomies for NSCLC with tumor size <7 cm and pathologic N1/N2. Socioeconomic factors comprised SDH scores, where SDH negative (-) was considered if SDH ≥2 (disadvantage); otherwise, SDH was positive (+). TOO+ was defined as R0 resection, ≥5 lymph nodes resected, hospital stay <75th percentile, no 30-day mortality, adjuvant chemotherapy initiation ≤3 months, and no unplanned readmission. If one of these parameters was not achieved, the case was considered TOO-. Results Of 11,274 patients, 48% of cases were TOO+ and 38% were SDH+. A total of 15% of patients were SDH- and were less likely (adjusted odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92) to achieve TOO+ than patients with SDH+. After accounting for confounders, patients with TOO+ had 22% lower overall mortality than patients with TOO- (adjusted hazard ratio, 0.78; CI, 0.73-0.82). In contrast, SDH- remained an independently significant risk factor, reducing survival by 24% compared with SDH+ (adjusted hazard ratio, 1.24; CI, 1.17-1.32). The impact of SDH on OS was significant for both patients with TOO+ and TOO-: SDH+/TOO+ had the best OS and SDH-/TOO-had the worst OS. Conclusions SDH score has a significant association with TOO achievement and TOO-driven overall posttreatment survival in patients with lobectomy-resected NSCLC with postoperative pathologic N1/N2 nodal metastasis. Addressing SDH is important to optimize care and long-term survival of this patient population.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Syed S. Razi
- Division of Thoracic Surgery, Hackensack Meridian Health, Edison, NJ
| | - Karishma Kodia
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Nestor Villamizar
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Dao M. Nguyen
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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17
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Emmerick ICM, Campos MR, Castanheira D, Muzy J, Marques A, Arueira Chaves L, Sobreira da Silva MJ. Lung Cancer Screening in Brazil Comparing the 2013 and 2021 USPSTF Guidelines. JAMA Netw Open 2023; 6:e2346994. [PMID: 38079172 PMCID: PMC10714246 DOI: 10.1001/jamanetworkopen.2023.46994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
Importance It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results In Brazil, the eligible population for LCS was 27 280 920 ever-smokers aged 50 to 80 years (13 387 552 female [49.1%]; 13 249 531 [48.6%] aged 50-60 years; 394 994 Asian or Indigenous [1.4%]; 3 111 676 Black [11.4%]; 10 942 640 Pardo [40.1%]; 12 830 904 White [47.0%]; 12 428 536 [45.6%] with an incomplete middle school education; and 12 860 132 [47.1%] living in the Southeast region); 5 144 322 individuals met the USPSTF 2013 criteria for LCS (2 090 636 female [40.6%]; 2 290 219 [44.5%] aged 61-70 years; 66 430 Asian or Indigenous [1.3%]; 491 527 Black [9.6%]; 2 073 836 Pardo [40.3%]; 2 512 529 [48.8%] White; 2 436 221 [47.4%] with an incomplete middle school education; and 2 577 300 [50.1%] living in the Southeast region), and 8 380 279 individuals met the USPSTF 2021 LCS criteria (3 507 760 female [41.9%]; 4 352 740 [51.9%] aged 50-60 years; 119 925 Asian or Indigenous [1.4%]; 839 171 Black [10.0%]; 3 330 497 Pardo [39.7%]; 4 090 687 [48.8%] White; 4 022 784 [48.0%] with an incomplete middle school education; and 4 162 070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.
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Affiliation(s)
| | - Mônica Rodrigues Campos
- Departamento de Ciências Sociais, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Debora Castanheira
- Laboratório de Pesquisa Clínica em DST e Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jessica Muzy
- Laboratório de Informações em Saúde, Instituto de Comunicação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Aline Marques
- Laboratório de Informações em Saúde, Instituto de Comunicação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luisa Arueira Chaves
- Instituto de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
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Leon C, Manley E, Neely AM, Castillo J, Ramos Correa M, Velarde DA, Yang M, Puente PE, Romero DI, Ren B, Chai W, Gladstone M, Lamango NS, Huang Y, Offringa IA. Lack of racial and ethnic diversity in lung cancer cell lines contributes to lung cancer health disparities. Front Oncol 2023; 13:1187585. [PMID: 38023251 PMCID: PMC10651223 DOI: 10.3389/fonc.2023.1187585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Lung cancer is the leading cause of cancer death in the United States and worldwide, and a major source of cancer health disparities. Lung cancer cell lines provide key in vitro models for molecular studies of lung cancer development and progression, and for pre-clinical drug testing. To ensure health equity, it is imperative that cell lines representing different lung cancer histological types, carrying different cancer driver genes, and representing different genders, races, and ethnicities should be available. This is particularly relevant for cell lines from Black men, who experience the highest lung cancer mortality in the United States. Here, we undertook a review of the available lung cancer cell lines and their racial and ethnic origin. We noted a marked imbalance in the availability of cell lines from different races and ethnicities. Cell lines from Black patients were strongly underrepresented, and we identified no cell lines from Hispanic/Latin(x) (H/L), American Indian/American Native (AI/AN), or Native Hawaiian or other Pacific Islander (NHOPI) patients. The majority of cell lines were derived from White and Asian patients. Also missing are cell lines representing the cells-of-origin of the major lung cancer histological types, which can be used to model lung cancer development and to study the effects of environmental exposures on lung tissues. To our knowledge, the few available immortalized alveolar epithelial cell lines are all derived from White subjects, and the race and ethnicity of a handful of cell lines derived from bronchial epithelial cells are unknown. The lack of an appropriately diverse collection of lung cancer cell lines and lung cancer cell-of-origin lines severely limits racially and ethnically inclusive lung cancer research. It impedes the ability to develop inclusive models, screen comprehensively for effective compounds, pre-clinically test new drugs, and optimize precision medicine. It thereby hinders the development of therapies that can increase the survival of minority and underserved patients. The noted lack of cell lines from underrepresented groups should constitute a call to action to establish additional cell lines and ensure adequate representation of all population groups in this critical pre-clinical research resource.
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Affiliation(s)
- Christopher Leon
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Aaron M. Neely
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Hastings Center for Pulmonary Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Castillo
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michele Ramos Correa
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Diego A. Velarde
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Minxiao Yang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pablo E. Puente
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Diana I. Romero
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Bing Ren
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Wenxuan Chai
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Matthew Gladstone
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nazarius S. Lamango
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, FL, United States
| | - Yong Huang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Ite A. Offringa
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Hastings Center for Pulmonary Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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19
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Thuo N, Martins T, Manley E, Standifer M, Sultan DH, Faris NR, Hill A, Thompson M, Jeremiah R, Al Achkar M. Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study. BMJ Open 2023; 13:e073886. [PMID: 37899158 PMCID: PMC10619042 DOI: 10.1136/bmjopen-2023-073886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients. METHODS We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model. RESULTS From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure. CONCLUSIONS BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.
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Affiliation(s)
- Nicholas Thuo
- Family Medicine, Univeristy of Washington, Seattle, WA, USA
| | - Tanimola Martins
- Health and Community Science, University of Exeter, Exeter, UK
- Health and Community Science, University of Exeter, Exeter, UK
| | | | - Maisha Standifer
- Health Policy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Angela Hill
- Pharmacotherapuetics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | | | - Rohan Jeremiah
- Global Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Morhaf Al Achkar
- Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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20
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Behinaein P, Treffalls J, Hutchings H, Okereke IC. The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer. Curr Oncol 2023; 30:7019-7030. [PMID: 37504369 PMCID: PMC10378348 DOI: 10.3390/curroncol30070509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lung cancer is the most common cancer killer in the world. The standard of care for surgical treatment of non-small cell lung cancer has been lobectomy. Recent studies have identified that sublobar resection has non-inferior survival rates compared to lobectomy, however. Sublobar resection may increase the number of patients who can tolerate surgery and reduce postoperative pulmonary decline. Sublobar resection appears to have equivalent results to surgery in patients with small, peripheral tumors and no lymph node disease. As the utilization of segmentectomy increases, there may be some centers that perform this operation more than other centers. Care must be taken to ensure that all patients have access to this modality. Future investigations should focus on examining the outcomes from segmentectomy as it is applied more widely. When employed on a broad scale, morbidity and survival rates should be monitored. As segmentectomy is performed more frequently, patients may experience improved postoperative quality of life while maintaining the same oncologic benefit.
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Affiliation(s)
- Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - John Treffalls
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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21
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Griesemer I, Lightfoot AF, Eng E, Bosire C, Guerrab F, Kotey A, Alexander KM, Baker S, Black KZ, Dixon C, Ellis KR, Foley K, Goettsch C, Moore A, Ryals CA, Smith B, Yongue C, Cykert S, Robertson LB. Examining ACCURE's Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care. Health Promot Pract 2023; 24:415-425. [PMID: 36582178 PMCID: PMC11384289 DOI: 10.1177/15248399221136534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.
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Affiliation(s)
- Ida Griesemer
- VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA
| | - Eugenia Eng
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire Bosire
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Community-Campus Partnerships for Health, Raleigh, NC
| | - Amanda Kotey
- Alliant Health Solutions, Inc., Atlanta, GA, USA
| | - Kimberly M Alexander
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The Alexander Group, Durham, NC, USA
- Elon University, Elon, NC, USA
| | - Stephanie Baker
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Elon University, Elon, NC, USA
| | - Kristin Z Black
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- East Carolina University, Greenville, NC, USA
| | - Crystal Dixon
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Wake Forest University, Winston-Salem, NC, USA
| | - Katrina R Ellis
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Karen Foley
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Antionette Moore
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Winston-Salem State University, Winston-Salem, NC, USA
| | - Cleo A Ryals
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cone Health Cancer Center, Greensboro, NC, USA
| | - Beth Smith
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Christina Yongue
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Samuel Cykert
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Pasli M, Kannaiyan R, Namireddy P, Walker P, Muzaffar M. Impact of Race on Outcomes of Advanced Stage Non-Small Cell Lung Cancer Patients Receiving Immunotherapy. Curr Oncol 2023; 30:4208-4221. [PMID: 37185434 PMCID: PMC10136836 DOI: 10.3390/curroncol30040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The impact of race in advanced stage non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) is conflicting. Our study sought to examine racial disparities in time to treatment initiation (TTI), overall survival (OS), and progression-free survival (PFS) using a population that was almost equally black and white. METHODS This was a retrospective cohort study of stage IV NSCLC patients > 18 years receiving immunotherapy at our center between 2014 and 2021. Kaplan-Meier curves and the multivariate Cox proportional hazards model determined the predictors of OS and PFS. Analyses were undertaken using IBM PSAW (SPSS v.28). RESULTS Out of 194 patients who met the inclusion criteria, 42.3% were black (n = 82). In the multivariate analysis, there was no difference in PFS (HR: 0.96; 95% CI: 0.66,1.40; p = 0.846) or OS (HR: 0.99; 95% CI: 0.66, 1.48; p = 0.966). No difference in treatment selection was observed between white and black patients (p = 0.363), nor was there a difference observed in median time to overall treatment initiation (p = 0.201). CONCLUSIONS No difference was observed in OS and PFS in black and white patients. Black patients' reception of timelier immunotherapy was an unanticipated finding. Future studies are necessary to better understand how race impacts patient outcomes.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA
| | - Radhamani Kannaiyan
- Division of Hospital Medicine, Eat Carolina University Health, 2100 Stantonsburg Road, Greenville, NC 27834, USA
| | - Praveen Namireddy
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
| | | | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
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23
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Hong JH, Swami N, Dee EC, Gomez SL, Lam MB. Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women. J Surg Oncol 2023; 127:882-890. [PMID: 36719164 DOI: 10.1002/jso.27204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). METHODS Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. RESULTS AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. CONCLUSIONS Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.
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Affiliation(s)
- Ji Hyun Hong
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nishwant Swami
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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24
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Casagrande GMS, Silva MDO, Reis RM, Leal LF. Liquid Biopsy for Lung Cancer: Up-to-Date and Perspectives for Screening Programs. Int J Mol Sci 2023; 24:2505. [PMID: 36768828 PMCID: PMC9917347 DOI: 10.3390/ijms24032505] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023] Open
Abstract
Lung cancer is the deadliest cancer worldwide. Tissue biopsy is currently employed for the diagnosis and molecular stratification of lung cancer. Liquid biopsy is a minimally invasive approach to determine biomarkers from body fluids, such as blood, urine, sputum, and saliva. Tumor cells release cfDNA, ctDNA, exosomes, miRNAs, circRNAs, CTCs, and DNA methylated fragments, among others, which can be successfully used as biomarkers for diagnosis, prognosis, and prediction of treatment response. Predictive biomarkers are well-established for managing lung cancer, and liquid biopsy options have emerged in the last few years. Currently, detecting EGFR p.(Tyr790Met) mutation in plasma samples from lung cancer patients has been used for predicting response and monitoring tyrosine kinase inhibitors (TKi)-treated patients with lung cancer. In addition, many efforts continue to bring more sensitive technologies to improve the detection of clinically relevant biomarkers for lung cancer. Moreover, liquid biopsy can dramatically decrease the turnaround time for laboratory reports, accelerating the beginning of treatment and improving the overall survival of lung cancer patients. Herein, we summarized all available and emerging approaches of liquid biopsy-techniques, molecules, and sample type-for lung cancer.
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Affiliation(s)
| | - Marcela de Oliveira Silva
- Molecular Oncology Research Center, Barretos Cancer Hospital, 1331 Rua Antenor Duarte Vilela, Barretos 14784-400, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, 1331 Rua Antenor Duarte Vilela, Barretos 14784-400, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Letícia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, 1331 Rua Antenor Duarte Vilela, Barretos 14784-400, Brazil
- Barretos School of Medicine Dr. Paulo Prata—FACISB, Barretos 14785-002, Brazil
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25
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Increased Utilization of Stereotactic Body Radiotherapy is Associated with Decreased Disparities and Improved Survival for Early-Stage NSCLC. Clin Lung Cancer 2023; 24:60-71. [PMID: 36289032 DOI: 10.1016/j.cllc.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We sought to determine if increased use of stereotactic body radiation therapy (SBRT) was associated with decreased disparities in the receipt of definitive treatment for early-stage non-small cell lung cancer (NSCLC). METHODS The National Cancer Database (NCDB) was utilized to determine the proportion of patients with NSCLC receiving surgery, SBRT, or no definitive treatment for clinical cT1-2aN0M0 NSCLC from 2004-2017. Univariable and multivariable logistic regressions were used. Age-adjusted mortality rates were calculated using the Surveillance, Epidemiology, and End Result (SEER) database. RESULTS From 2004 to 2017, the proportion of early-stage NSCLC undergoing no definitive treatment declined from 22% to 10.5% (P<.001), while the proportion receiving SBRT increased from 1% (0.9%-1.3%) to 22% (21.4%-22.3%; P<.001). Among Whites, the proportion undergoing no definitive treatment decreased from 21% to 10% (P<.001), as compared to Blacks, which had a higher decrease, of 32% to 15% (P<.001). The proportion of Blacks receiving SBRT increased from 1% (0.3%-1.7%) to 22% (20.8%-23.5%) (P<.001). Between 2011 and 2017 likelihood of Blacksreceiving curative therapy increased compared to Whites [OR: 0.55 (0.48-0.64) to 0.70 (0.62-0.79; P<.001]. Furthermore, the age-adjusted mortality rate of early-stage NSCLC decreased from 4.3 (4.0-4.5) in 2004 to 0.8 (0.7-0.9) in 2017 (P<.001). CONCLUSIONS Increased utilization of SBRT significantly increased the proportion of patients receiving curative therapy for early-stage NSCLC and was associated with an improvement in mortality. Furthermore, the use of SBRT reduced previously seen disparities in receipt of treatment between Whites and Blacks. SBRT was also associated with decreased mortality from early-stage NSCLC.
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26
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Katipally RR, Spurr LF, Gutiontov SI, Turchan WT, Connell P, Juloori A, Malik R, Binkley MS, Jiang AL, Rouhani SJ, Chervin CS, Wanjari P, Segal JP, Ng V, Loo BW, Gomez DR, Bestvina CM, Vokes EE, Ferguson MK, Donington JS, Diehn M, Pitroda SP. STK11 Inactivation Predicts Rapid Recurrence in Inoperable Early-Stage Non-Small-Cell Lung Cancer. JCO Precis Oncol 2023; 7:e2200273. [PMID: 36603171 PMCID: PMC10530422 DOI: 10.1200/po.22.00273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/04/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Molecular factors predicting relapse in early-stage non-small-cell lung cancer (ES-NSCLC) are poorly understood, especially in inoperable patients receiving radiotherapy (RT). In this study, we compared the genomic profiles of inoperable and operable ES-NSCLC. MATERIALS AND METHODS This retrospective study included 53 patients with nonsquamous ES-NSCLC (stage I-II) treated at a single institution (University of Chicago) with surgery (ie, operable; n = 30) or RT (ie, inoperable; n = 23) who underwent tumor genomic profiling. A second cohort of ES-NSCLC treated with RT (Stanford, n = 39) was included to power clinical analyses. Prognostic gene alterations were identified and correlated with clinical variables. The primary clinical end point was the correlation of prognostic genes with the cumulative incidence of relapse, disease-free survival, and overall survival (OS) in a pooled RT cohort from the two institutions (N = 62). RESULTS Although the surgery cohort exhibited lower rates of relapse, the RT cohort was highly enriched for somatic STK11 mutations (43% v 6.7%). Receiving supplemental oxygen (odds ratio [OR] = 5.5), 20+ pack-years of tobacco smoking (OR = 6.1), and Black race (OR = 4.3) were associated with increased frequency of STK11 mutations. In the pooled RT cohort (N = 62), STK11 mutation was strongly associated with inferior oncologic outcomes: 2-year incidence of relapse was 62% versus 20% and 2-year OS was 52% versus 85%, remaining independently prognostic on multivariable analyses (relapse: subdistribution hazard ratio = 4.0, P = .0041; disease-free survival: hazard ratio, 6.8, P = .0002; OS: hazard ratio, 6.0, P = .022). STK11 mutations were predominantly associated with distant failure, rather than local. CONCLUSION In this cohort of ES-NSCLC, STK11 inactivation was associated with poor oncologic outcomes after RT and demonstrated a novel association with clinical hypoxia, which may underlie its correlation with medical inoperability. Further validation in larger cohorts and investigation of effective adjuvant systemic therapies may be warranted.
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Affiliation(s)
- Rohan R. Katipally
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Liam F. Spurr
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
- The Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Stanley I. Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - William Tyler Turchan
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Philip Connell
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Aditya Juloori
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Renuka Malik
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
| | - Michael S. Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Alice L. Jiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Sherin J. Rouhani
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Carolina Soto Chervin
- Section of Hematology/Oncology, Department of Medicine, NorthShore University HealthSystem, Evanston, IL
| | - Pankhuri Wanjari
- Department of Pathology, University of Chicago Medicine, Chicago, IL
| | - Jeremy P. Segal
- Department of Pathology, University of Chicago Medicine, Chicago, IL
| | - Victor Ng
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christine M. Bestvina
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Everett E. Vokes
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Mark K. Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Jessica S. Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Sean P. Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL
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Okelo SO. Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:752-762. [DOI: 10.1055/s-0042-1756491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractStructural inequities in medicine have been present for centuries in the United States, but only recently are these being recognized as contributors to racial inequities in asthma care and asthma outcomes. This chapter provides a systematic review of structural factors such as racial bias in spirometry algorithms, the history of systemic racism in medicine, workforce/pipeline limitations to the presence of underrepresented minority health care providers, bias in research funding awards, and strategies to solve these problems.
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Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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28
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Luo X, Zhou Z, Zeng X, Peng L, Liu Q. Cost-effectiveness of ensartinib, crizotinib, ceritinib, alectinib, brigatinib and lorlatinib in patients with anaplastic lymphoma kinase-positive non-small cell lung cancer in China. Front Public Health 2022; 10:985834. [PMID: 36211665 PMCID: PMC9533130 DOI: 10.3389/fpubh.2022.985834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Six anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs), including one domestic (ensartinib) and five imported ALK-TKIs (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib), have been recommended as first-line treatments for advanced ALK-positive NSCLC in China. This study sought to examine the cost-effectiveness of these six novel therapies in Chinese patients. Material and methods We constructed a Markov model to compare the cost-effectiveness of the six ALK-TKIs as a first-line treatment for patients with advanced ALK-positive NSCLC from the perspective of the Chinese healthcare system. Transition probabilities were estimated by synthesizing data from the PROFILE 1,029 trial and a network meta-analysis. Health state utilities and costs were sourced from published literature, publicly available national databases, and local general hospitals. The robustness of model was assessed via deterministic sensitivity analyses and probabilistic sensitivity analyses. Results Compared with crizotinib, ensartinib achieved additional 0.12 quality-adjusted life-year (QALY) with marginal costs of $3,249, resulting in an incremental cost-effectiveness ratio (ICER) of $27,553/ QALY. When compared with ceritinib and brigatinib, ensartinib achieved additional 0.06 and 0.03 QALYs with substantially reduced costs. When compared with lorlatinib and alectinib, ensartinib was associated with a lower QALY and decreased total costs; the ICERs for lorlatinib and alectinib were $934,101/ QALY and $164,888/ QALY, respectively. Conclusion For Chinese patients with advanced ALK-positive NSCLC, ensartinib was a cost-effective option compared with crizotinib, and was a dominant alternative to ceritinib and brigatinib. Although lorlatinib and alectinib were associated with prolonged survival compared with ensartinib, they were less cost-effective than ensartinib due to the overwhelming total costs.
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Affiliation(s)
- Xia Luo
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xiaohui Zeng
- Department of Nuclear Medicine/PET Image Center, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Liubao Peng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiao Liu
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, China
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29
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Zhu RY, Chen H, Gao YJ, Pan ZH, Wang JY. Effects of psychological nursing care on anxiety and depression in perioperative patients with lung cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29914. [PMID: 35866819 PMCID: PMC9302294 DOI: 10.1097/md.0000000000029914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effects of psychological nursing care (PNC) on anxiety relief in perioperative lung cancer (LC) patients. METHODS We searched the Cochrane Library, PubMed, Embase, CNKI, CBM, and Wangfang electronic databases from inception to May 1, 2022. Eligible randomized controlled trials (RCTs) investigating the effects and safety of PNC on anxiety relief in perioperative LC patients. Anxiety was the primary outcome measure. The secondary outcomes were depression, length of hospital stay, and the occurrence of adverse events. RESULTS Six eligible RCTs with 494 patients were included in this study. Compared with routine nursing care, PNC showed better outcomes in terms of anxiety relief (mean difference [MD] = -13.24; random 95% confidence interval (CI), -18.28 to -8.20; P<.001), depression decrease (MD = -11.84; random 95% CI, -18.67 to -5.01; P < .001), and length of hospital stay (MD = -2.6; fixed 95% CI, -3.13 to -2.07; P < .001). No data on adverse events were pooled because only 1 trial reported this outcome. CONCLUSIONS This study showed that PNC may benefit more than routine nursing care for patients with LC in anxiety, depression, and length of hospital stay. High-quality RCTs are needed to validate the current findings in the future.
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Affiliation(s)
- Ren-Ying Zhu
- Infection Control Division, Hongqi Hospital Affiliated To Mudanjiang Medical University, Mudanjiang, China
| | - Hong Chen
- Department of Dermatology, Hongqi Hospital Affiliated To Mudanjiang Medical University, Mudanjiang, China
| | - Yue-Juan Gao
- Department of Pharmacy, Hongqi Hospital Affiliated To Mudanjiang Medical University, Mudanjiang, China
| | - Zhi-Han Pan
- Department of Nursing Care, Nursing Care College, Mudanjiang Medical University, Mudanjiang, China
| | - Jiu-Ying Wang
- Department of Pre-examination and Triage Outpatient, Hongqi Hospital Affiliated To Mudanjiang Medical University, Mudanjiang, China
- *Correspondence: Corresponding address: Jiu-Ying Wang, Department of Preexamination and Triage Outpatient, Hongqi Hospital Affiliated To Mudanjiang Medical University, No.5 Tongxiang Street, Aimin District, Mudanjiang 157011, China, (e-mail: )
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Zeng L, Zeng G, Ye Z. Bioinformatics Analysis for Identifying Differentially Expressed MicroRNAs Derived from Plasma Exosomes Associated with Radiotherapy Resistance in Non-Small-Cell Lung Cancer. Appl Bionics Biomech 2022; 2022:9268206. [PMID: 35685351 PMCID: PMC9173951 DOI: 10.1155/2022/9268206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/30/2022] [Indexed: 01/15/2023] Open
Abstract
Objective To explore the differentially expressed microRNAs (DEmiRs) derived from plasma exosomes related to radiotherapy resistance and their corresponding pathways in non-small-cell lung cancer (NSCLC). Methods Plasma samples from NSCLC patients were retrieved and analyzed. The patients were divided into 3 groups based on the tumor regression grade criteria, assessed by radiological imaging after radiotherapy. TRG1 referred to tumor shrinkage of ≤30% after radiotherapy, TRG2 as 30% < TRG < 50%, and TRG3 as TRG ≥ 50%. High-throughput sequencing and bioinformatics analysis were used to compare the DEmiRs between the three groups. The miRanda, PITA, and RNAhybrid software were used to identify potential target genes of the DEmiRs. GO function enrichment and KEGG pathway enrichment analyses were performed on the target gene set. Results There were 24 DEmiRs (12 were upregulated and 12 downregulated) between the TRG1 and TRG2 groups, 11 between the TRG1 and TRG3 groups (6 upregulated and 5 downregulated), and 35 between the TRG2 and TRG3 groups. The common DEmiRs between the three groups were miR-92a-3p. GO analysis showed that the target genes of the DEmiRs were mainly enriched in unicellular organism processes, cell transformation, cell localization, and their establishment. KEGG enrichment analysis showed that target genes were significantly enriched in the Ras signaling pathway and associated with endocytosis. Among the 135 identified target genes of miR-92a-3p, 4 were involved in the PI3K-Akt signaling pathway (the downstream pathway of the Ras gene) and 3 in the cAMP signaling pathway (the upstream pathway of the Ras gene). Further, 2 other target genes were involved in the Rap1 signaling pathway (the upstream pathway of PI3K-Akt). Conclusion By assessing the expression and functional profile of DEmiRs in the plasma exosomes of NSCLC patients after radiotherapy, miR-92a-3p was identified as a promising target affecting radiotherapy outcomes through the Ras signaling pathway.
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Affiliation(s)
- Lirong Zeng
- Chengdu Railway Health School, Chengdu, China
| | - Guilin Zeng
- Chengdu Fifth People's Hospital, Chengdu, China
| | - Zhong Ye
- Chengdu Railway Health School, Chengdu, China
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