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Haghparast M, Evazi MR, Darvish L. Tobacco smoking influences the side effects of radiation therapy-managed patients with various malignancies: A systematic review. J Med Imaging Radiat Sci 2024; 55:101430. [PMID: 38870612 DOI: 10.1016/j.jmir.2024.05.003] [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: 02/07/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Tobacco smoking may decrease the effectiveness of radiation therapy. This is because tobacco smoking can cause inflammation and damage to surrounding tissues, which may interfere with radiation delivery to the tumor. Our aim of this study is to investigate the effect of tobacco smoking use on complications in radiotherapy as a systematic review. METHOD The articles searched from the MEDLINE, PubMed, EMBASE, and Web of Science databases. The search terms used were "radiotherapy", "outcome", "radiation therapy", "tobacco", "smoking", "complications", "side effects", "cancer", and "malignancy". PRISMA check list was used to assess the overall quality of evidence for each outcome. RESULT The outcomes of radiotherapy-inducing tobacco smoking in smokers are more than non-smokers including; high SPC (second primary cancer), decreased median overall survival, higher infections during treatment, increased fatigue (p = 0.027), increased pain (p = 0.009), poorer cognitive function (0.041), affected mouth opening (0.049), more speech disturbances (p = 0.017), higher metastasis risk (p = 0.031 and 0.019), higher locoregional recurrence risk (p = 0.027), oral mucositis (p = 0.03), mucositis severity related to higher tobacco exposure (p = 0.008), severe acute radiation skin reactions, and myocardial infarction. DISCUSSION Tobacco smoking appears to be the most significant modifiable factor influencing cancer treatment outcomes. As such, healthcare providers should take detailed notes on patients' smoking histories during both routine and future clinical studies. Beyond immediate cessation, cancer patients should undertake comprehensive smoking cessation programs. These programs can significantly boost the efficacy of radiotherapy and enhance overall patient outcomes.
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Affiliation(s)
- Mohammad Haghparast
- Department of Radiology, Faculty of ParaMedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Reza Evazi
- Hematologist and Medical Oncologist, Hormozgan University of Medical Science, Bandar Abbas, Iran
| | - Leili Darvish
- Department of Radiology, Faculty of ParaMedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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2
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Lai H, Liu Q, Ye Q, Liang Z, Long Z, Hu Y, Wu Q, Jiang M. Impact of smoking cessation duration on lung cancer mortality: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 196:104323. [PMID: 38462148 DOI: 10.1016/j.critrevonc.2024.104323] [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: 12/09/2023] [Revised: 02/11/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Smoking history is a heterogeneous situation for different populations, and numerous studies suggest that smoking cessation is conducive to reduce the mortality of lung cancer. However, no quantitative meta-analysis regarding smoking cessation duration based on different populations has demonstrated it clearly. METHODS We systematically searched four electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scoups) till February 2023. Eligible studies reported the association between lung cancer survival and duration of smoking cessation. Additionally, we stratified the study population according to whether they had lung cancer at the time they quit smoking. Studies were pooled with the random-effects model. RESULTS Out of the 11,361 potential studies initially identified, we included 24 studies involving 969,560 individuals in our analysis. Lung cancer mortality varied across two groups: general quitters and peri-diagnosis quitters. For general quitters, those who had quit smoking for less than 10 years exhibited an RR of 0.64 (95% CI [0.55-0.76]), while those who quit for 10-20 years had an RR of 0.33 (0.25-0.43), over 20 years had an RR of 0.16 (0.11-0.24), and never-smokers had an RR at 0.11 (0.07-0.15). Among peri-diagnosis quitters, the 1-year Overall Survival (OS) showed an RR of 0.80 (0.67-0.96), the 2-year OS had an RR of 0.89 (0.80-0.98), the 3-year OS had an RR of 0.93 (0.84-1.03), and the 5-year OS had an RR of 0.85 (0.76-0.96). CONCLUSIONS Earlier and longer smoking cessation is associated with reduced lung cancer mortality, no matter in which cessation stage for two different populations.
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Affiliation(s)
- Hongkun Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Quanzhen Liu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Qianxian Ye
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Ziyang Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Zhiwei Long
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Yinghong Hu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Qianlong Wu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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Orfanakos K, Alifieris CE, Verigos EK, Deligiorgi MV, Verigos KE, Panayiotidis MI, Nikolaou M, Trafalis DT. The Predictive Value of 8-Hydroxy-Deoxyguanosine (8-OHdG) Serum Concentrations in Irradiated Non-Small Cell Lung Carcinoma (NSCLC) Patients. Biomedicines 2024; 12:134. [PMID: 38255239 PMCID: PMC10813052 DOI: 10.3390/biomedicines12010134] [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: 11/26/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Ionizing radiation is strongly linked to direct or indirect DNA damage, as with the production of reactive oxygen species (ROS), which in turn produce DNA damage products, such as 8-hydroxy-2-deoxyguanosine (8-OHdG). In this study, we aimed to investigate the formation of 8-OHdG after irradiation in patients with non-small cell cancer (NSCLC) and its use as a biomarker. Sixteen patients with squamous and thirty-six patients with non-squamous pathology were included. An enzyme-linked-immunosorbent assay (ELISA) was performed before and after radiation. A dose-dependent relationship was confirmed: 8-OHdG plasma concentrations, increased in the total of NSCLC patients and specifically with a linear correlation in non-squamous pathology; in squamous histology, after an initial increase, a significant decrease followed after 20 Gy dose of irradiation. The pretreatment total irradiated tumor volume (cm3) was positively correlated with 8-OHdG levels in patients with squamous histology. When plotting the 8-OHdG plasma concentration at a 10 Gy irradiation dose to the baseline, the AUC was 0.873 (95% CI 0.614-0.984), p < 0.0001, with an associated criterion value of >1378 as a cutoff (sensitivity 72.7%, specificity 100%). When normalizing this ratio to BSA, the associated criterion cutoff value was >708 (sensitivity of 100%, specificity 80%). Lastly, 8-OHdG levels were closely related with the development of radiation-induced toxicities.
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Affiliation(s)
- Kyriakos Orfanakos
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
- Department of Radiation Therapy, 401 General Military Hospital, 11525 Athens, Greece
| | - Constantinos E. Alifieris
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
- Department of Hepatobiliary and Transplant Surgery, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Emmanouil K. Verigos
- Department of Radiation Oncology, General Anticancer Oncology Hospital of Athens “O Agios Savvas”, 11522 Athens, Greece
| | - Maria V. Deligiorgi
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
| | - Kosmas E. Verigos
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
- Department of Radiation Therapy, 401 General Military Hospital, 11525 Athens, Greece
| | - Mihalis I. Panayiotidis
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology & Genetics, Nicosia 2371, Cyprus
| | - Michail Nikolaou
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
| | - Dimitrios T. Trafalis
- Laboratory of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.O.); (M.V.D.); (K.E.V.); (D.T.T.)
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de Oliveira TB, Fontes DMN, Montella TC, Lewgoy J, Dutra C, Miola TM. The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 31:183-202. [PMID: 38248097 PMCID: PMC10814676 DOI: 10.3390/curroncol31010012] [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: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.
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Affiliation(s)
| | | | | | - Jairo Lewgoy
- Medical Oncology Department, Hospital Mãe de Deus, Porto Alegre 90880-481, Brazil;
| | - Carolina Dutra
- Medical Oncology Department, Clínica Soma, Florianópolis 88020-210, Brazil;
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Burnett C, Bestall JC, Burke S, Morgan E, Murray RL, Greenwood-Wilson S, Williams GF, Franks KN. Prehabilitation and Rehabilitation for Patients with Lung Cancer: A Review of Where we are Today. Clin Oncol (R Coll Radiol) 2022; 34:724-732. [PMID: 36088168 DOI: 10.1016/j.clon.2022.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
Lung cancer is the third most common type of cancer in the UK, with nearly 50 000 new cases diagnosed a year. Treatments for lung cancer have improved in recent years with the advent of new surgical and radiotherapy techniques and the increased use of immunotherapies. These advances have resulted in increasing numbers of patients surviving beyond the completion of their treatment. Lung cancer patients are now not dying from their cancer diagnosis, but from other co-existing pathologies. Lung cancer patients commonly present with multiple comorbidities. Mitigating the effects of poor lifestyles and changing behaviours may improve the efficacy of treatments, reduce side-effects and improve the quality of life for lung cancer patients. Published evidence supports the use of interventions to manage behavioural habits, to optimise the health of patients. There is no consensus as to what, when or how to embed these into the patient pathway. Supporting patients before, during and after their cancer treatments to increase activity, eat well and stop smoking have been seen to decrease side-effects and improve patient outcomes and wellbeing. The challenge is to provide a package of interventions that is acceptable to patients and fits within the patient pathway so as not to conflict with diagnostic and therapeutic activities. This article reviews where we are today with providing behavioural support to optimise the health of lung cancer patients undergoing treatment.
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Affiliation(s)
- C Burnett
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's Hospital, University of Leeds, Leeds, UK.
| | - J C Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - S Burke
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - E Morgan
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's Hospital, University of Leeds, Leeds, UK
| | - R L Murray
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Greenwood-Wilson
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's Hospital, University of Leeds, Leeds, UK
| | - G F Williams
- Department of Nutrition and Dietetics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K N Franks
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Avancini A, Belluomini L, Borsati A, Riva ST, Trestini I, Tregnago D, Dodi A, Lanza M, Pompili C, Mazzarotto R, Micheletto C, Motton M, Scarpa A, Schena F, Milella M, Pilotto S. Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer. Expert Rev Anticancer Ther 2022; 22:725-735. [PMID: 35608060 DOI: 10.1080/14737140.2022.2082410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events. AREAS COVERED Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting. EXPERT OPINION Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Teresa Riva
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Alessandra Dodi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cecilia Pompili
- Thoracic Surgery Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Section of Radiotherapy, Department of Surgery and Oncology, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Claudio Micheletto
- Pulmonary Unit, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimiliano Motton
- Radiology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
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Caini S, Del Riccio M, Vettori V, Scotti V, Martinoli C, Raimondi S, Cammarata G, Palli D, Banini M, Masala G, Gandini S. Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis. J Thorac Oncol 2022; 17:623-636. [PMID: 34995798 DOI: 10.1016/j.jtho.2021.12.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lung cancer (LC) remains a disease with poor prognosis despite recent advances in treatments. Here, we aimed at summarizing the current scientific evidence on whether quitting smoking at or around diagnosis has a beneficial effect on the survival of LC patients. METHODS We searched MEDLINE and EMBASE for articles published until 31st October, 2021, that quantified the impact on LC patients' survival of quitting smoking at or around diagnosis or during treatment. Study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models. RESULTS Twenty-one articles published between 1980 and 2021 were included, which encompassed a total of over 10,000 LC patients. There was substantial variability across studies in terms of design, patients' characteristics, treatments received, criteria used to define smoking status (quitters or continued), and duration of follow-up. Quitting smoking at or around diagnosis was significantly associated with improved overall survival (SRR 0.71, 95% CI 0.64-0.80), consistently among patients with non-small cell LC (SRR 0.77, 95% CI 0.66-0.90, n studies = 8), small cell LC (SRR 0.75, 95% CI 0.57-0.99, n studies = 4), or LC of both or unspecified histological type (SRR 0.81, 95% CI 0.68-0.96, n studies = 6). CONCLUSIONS Quitting smoking at or around diagnosis is associated with a beneficial effect on the survival of LC patients. Treating physicians should educate LC patients about the benefits of quitting smoking even after diagnosis and provide them with the necessary smoking cessation support.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Martinoli
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulio Cammarata
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Smoking-, Alcohol-, and Age-Related Alterations of Blood Monocyte Subsets and Circulating CD4/CD8 T Cells in Head and Neck Cancer. BIOLOGY 2022; 11:biology11050658. [PMID: 35625386 PMCID: PMC9138171 DOI: 10.3390/biology11050658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous malignant disease of the oral cavity, pharynx, and larynx. Although cigarette smoking, alcohol abuse, and aging are well-established associated factors for HNSCC, their respective influence on immunologic alterations of monocyte subsets or T-cell compositions in the peripheral blood has not yet been fully unveiled. Using flow cytometry, whole blood measurements of CD14/CD16 monocyte subsets and analyses of T-cell subsets in isolated PBMC fractions were carried out in 64 HNSCC patients in view of their tobacco and alcohol consumption, as well as their age, in comparison to healthy volunteers. Flow cytometric analysis revealed significantly increased expression of monocytic CD11b, as well as significantly decreased expression levels of CX3CR1 on classical and intermediate monocyte subsets in smoking-related and in alcohol-related HNSCC patients compared to healthy donors. Peripheral monocytes revealed an age-correlated significant decrease in PD-L1 within the entirety of the HNSCC cohort. Furthermore, we observed significantly decreased abundances of CD8+ effector memory T cells in active-smoking HNSCC patients and significantly increased percentages of CD8+ effector T cells in alcohol-abusing patients compared to the non-smoking/non-drinking patient cohort. Our data indicate an enhanced influence of smoking and alcohol abuse on the dynamics and characteristics of circulating monocyte subsets and CD4/CD8 T-cell subset proportions, as well as an age-related weakened immunosuppression in head and neck cancer patients.
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Impact of Tobacco Smoking on Outcomes of Radiotherapy: A Narrative Review. Curr Oncol 2022; 29:2284-2300. [PMID: 35448160 PMCID: PMC9031077 DOI: 10.3390/curroncol29040186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
The carcinogenic role of tobacco smoking is well recognized, but the detrimental effects of continued smoking after a cancer diagnosis have been underestimated. Radiotherapy is among the main treatment modalities for cancer. We reviewed the literature data concerning the impact of tobacco smoking on treatment outcomes in radiotherapy-managed patients with various malignancies. Most of the analyzed studies demonstrated the detrimental effect of smoking on overall survival, tumor control, quality of life, treatment toxicity, and the incidence of second primary malignancies. Healthcare professionals should use the cancer diagnosis and treatment as a teachable moment and recommend their patients to immediately cease smoking. Wherever possible, cancer patients should undergo an intensive smoking-cessation program, including behavioral and pharmacologic therapy.
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Holland JM, Holland E, Chen Y, Brown SA. Smoking history and cessation discussions in cancer patients receiving definitive radiotherapy: Do we treat all patients equally? Tob Prev Cessat 2020; 6:31. [PMID: 32760866 PMCID: PMC7398132 DOI: 10.18332/tpc/120308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Tobacco is recognized as a causative agent for head and neck (H&N) and lung cancers, but not for cancers of the prostate or breast. Still, tobacco use during radiotherapy has been associated with poorer outcomes for all four of these commonly treated malignancies. We sought to evaluate if our providers record smoking history and discuss cessation as frequently for prostate and breast cancers as for H&N and lung cancers. METHODS Initial consultation notes of 592 non-metastatic patients seen from January 2014 through June 2017 were reviewed using the electronic medical record. Descriptive statistics were used to evaluate smoking history and cessation discussions. The chi-squared test was used to compare frequencies. We chose two cancer sites commonly associated with tobacco use and causation (H&N and lung) and two sites not commonly associated (prostate and breast). RESULTS Prostate cancer patients were less likely to have smoking history recorded (65%) than breast (91%), H&N (96%) or lung (97%) patients (p<0.0001). Breast and prostate cancer patients were less likely to be current smokers (10%) than H&N and lung cancer patients (29%) (p<0.0001). Smoking cessation discussions were less frequently documented in breast and prostate cancer patients (14%) than in H&N and lung cancer patients (55%) (p=0.0005). CONCLUSIONS We document smoking history less frequently for prostate cancer patients than H&N, lung or breast cancer patients. Breast and prostate cancer patients have lower rates of current smoking than H&N and lung cancer patients. We document smoking cessation discussions less frequently in current smoking breast and prostate cancer patients than current smoking H&N and lung cancer patients. As all of these patients have been shown to experience poorer outcomes when smoking during radiotherapy, all should be asked about their smoking history.
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Affiliation(s)
- John M Holland
- Department of Radiation Oncology, Oregon Health & Science University, Portland, United States
| | - Emily Holland
- Department of Radiation Oncology, Oregon Health & Science University, Portland, United States
| | - Yiyi Chen
- Department of Radiation Oncology, Oregon Health & Science University, Portland, United States
| | - Simon A Brown
- Department of Radiation Oncology, Oregon Health & Science University, Portland, United States
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De Ruysscher D, Faivre-Finn C, Nackaerts K, Jordan K, Arends J, Douillard J, Ricardi U, Peters S. Recommendation for supportive care in patients receiving concurrent chemotherapy and radiotherapy for lung cancer. Ann Oncol 2020; 31:41-49. [DOI: 10.1016/j.annonc.2019.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
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Wang T, Townsend MK, Simmons V, Terry KL, Matulonis UA, Tworoger SS. Prediagnosis and postdiagnosis smoking and survival following diagnosis with ovarian cancer. Int J Cancer 2019; 147:736-746. [PMID: 31693173 DOI: 10.1002/ijc.32773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/28/2019] [Accepted: 10/28/2019] [Indexed: 02/04/2023]
Abstract
Little is known about the influence of prediagnosis and postdiagnosis smoking and smoking cessation on ovarian cancer survival. We investigated this relationship in two prospective cohort studies, the Nurses' Health Study (NHS) and NHSII. Analyses included 1,279 women with confirmed invasive, Stage I-III epithelial ovarian cancer. We used Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ovarian cancer-specific mortality by smoking status, adjusting for age and year of diagnosis, tumor stage, histologic subtype, body mass index and nonsteroidal anti-inflammatory use (postdiagnosis models only). When examining prediagnosis smoking status (assessed a median of 12 months before diagnosis), risk of death was significantly increased for former smokers (HR = 1.19, 95% CI: 1.02-1.39), and suggestively for current smokers (HR = 1.21, 95% CI: 0.96-1.51) vs. never smokers. Longer smoking duration (≥20 years vs. never, HR = 1.23, 95% CI: 1.05-1.45) and higher pack-years (≥20 pack-years vs. never, HR = 1.28, 95% CI: 1.07-1.52) were also associated with worse outcome. With respect to postdiagnosis exposure, women who smoked ≥15 cigarettes per day after diagnosis (assessed a median of 11 months after diagnosis) had increased mortality compared to never smokers (HR = 2.34, 95% CI: 1.63-3.37). Those who continued smoking after diagnosis had 40% higher mortality (HR = 1.40, 95% CI: 1.05-1.87) compared to never smokers. Overall, our results suggest both prediagnosis and postdiagnosis smoking are associated with worse ovarian cancer outcomes.
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Affiliation(s)
- Tianyi Wang
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Vani Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.,Department of Oncologic Sciences, University of South Florida, Tampa, FL.,Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ursula A Matulonis
- Division of Gynecologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.,Department of Oncologic Sciences, University of South Florida, Tampa, FL.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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13
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Singer L, Sharee K, Boreta L, Silveira WR, Braunstein S, Fogh S. Quality Improvement Initiative to Improve Tobacco Cessation Efforts in Radiation Oncology. J Oncol Pract 2019; 15:e382-e388. [PMID: 30908138 DOI: 10.1200/jop.18.00593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although continued tobacco use in patients who are treated with radiation therapy is associated with inferior outcomes and increased treatment-related toxicity, multiple studies have shown that current tobacco cessation efforts in oncology are insufficient. A quality improvement (QI) initiative was developed with the goal of improving tobacco cessation efforts in radiation oncology. METHODS Using iterative plan-do-study-act cycles, barriers to tobacco cessation were identified and then addressed with a single-institutional QI initiative designed to improve physician assessment of patient readiness to quit tobacco by 50% or more. Residents assessed readiness to quit tobacco during new patient consultations and recorded this assessment in prespecified fields within the electronic health record. Feedback on assessment efforts was provided to our department via an automated search of the electronic health record. RESULTS From December 2014 to February 2015, before the initiation of the QI initiative, 4% of patients were assessed for their readiness to quit tobacco. After implementing the initiative, 67% of patients were assessed for their readiness to quit. CONCLUSION After instituting a QI initiative at our institution, significantly more patients were assessed for readiness to quit tobacco before treatment with radiation therapy. Ongoing efforts in our department are aimed at improving the efficacy of this intervention.
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Affiliation(s)
- Lisa Singer
- 1 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.,2 Harvard Medical School, Boston, MA
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Norum J, Nieder C. Tobacco smoking and cessation and PD-L1 inhibitors in non-small cell lung cancer (NSCLC): a review of the literature. ESMO Open 2018; 3:e000406. [PMID: 30305940 PMCID: PMC6173248 DOI: 10.1136/esmoopen-2018-000406] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Programmed death ligand 1 (PD-L1) targeting immunotherapies, as pembrolizumab and nivolumab, have significantly improved outcome in patients with non-small cell lung cancer (NSCLC). Tobacco smoking is the number one risk factor for lung cancer and is linked to 80%-90% of these cancers. Smoking during cancer therapy may influence on radiotherapy and chemotherapy outcome. We aimed to review the knowledge in immunotherapy. PATIENTS AND METHODS A systematic review was done. We searched for documents and articles published in English language and registered in Cochrane Library, National Health Service (NHS) Centre for Reviews and Dissemination (CRD), Embase or Medline. The search terms were (A) (Lung cancer or NSCLC) with (pembrolizumab or nivolumab) with PD-L1 with (tobacco or smoking) and (B) Lung Neoplasms and Immunotherapy and (smoking cessation or patient compliance). 68 papers were detected and two more were added during review process (references) and six based on information from the manufacturers. RESULTS Nine papers were selected. High PD-L1 expression (≥50%) was correlated with current/ever smoking history in three studies. Six studies revealed a higher overall response rate (ORR) among current/former smokers. The ORR was generally (six studies) better among the current/former smoker group. So also when tumours had a molecular 'smoking signature' (one study). This was probably due to a higher mutational burden. In two studies, minor or no difference was revealed.One study (KEYNOTE-024) compared former and current smokers, and documented pembrolizumab being more effective among former smokers than current smokers. CONCLUSIONS Tobacco smoking patients with NSCLC generally have a higher PD-L1 tumour proportion score and experience a better ORR of immunotherapy than no smokers. There is little evidence on the effect of smoking during immunotherapy, but one study (KEYNOTE-024) may indicate survival gains of smoking cessation.
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Affiliation(s)
- Jan Norum
- Department of Surgery, Finnmark Hospital, Hammerfest, Norway
| | - Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Science, UiT – The Arctic University of Norway, Tromsø, Norway
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Singer L, Braunstein S, Singer CM, Silveira WR, Fogh S. Residents' Views on Tobacco Cessation in Radiation Oncology. J Am Coll Radiol 2018; 16:102-105. [PMID: 30245215 DOI: 10.1016/j.jacr.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 08/17/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Lisa Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Cara M Singer
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee
| | | | - Shannon Fogh
- Department of Radiation Oncology, University of California, San Francisco, California
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16
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Rades D, Manig L, Janssen S, Schild SE. Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder. ACTA ACUST UNITED AC 2018; 31:741-744. [PMID: 28652450 DOI: 10.21873/invivo.11124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/14/2017] [Accepted: 04/19/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIM To contribute to personalisation of treatment for patients with carcinoma of the urinary bladder, 11 factors were analyzed for survival. PATIENTS AND METHODS Data from 61 patients receiving definitive irradiation for carcinoma of the urinary bladder were retrospectively evaluated, namely gender, age, T-stage, N-stage, grading, pack years, smoking during irradiation, upfront transurethral resection of the bladder tumour (TURBT), equivalent dose in 2-Gy fractions (EQD2), chemotherapy and Karnofsky performance score (KPS). RESULTS On univariate analysis, female gender (p=0.007), <40 pack years (p=0.029), not smoking during irradiation (p=0.037), TURBT (p=0.007) and KPS >70 (p<0.001) led to improved survival; EQD2 >55 Gy showed a trend (p=0.065) for such association. On Cox regression, gender [risk ratio (RR)=2.81; p=0.039], TURBT (RR=4.44; p=0.033) and KPS (RR=3.45; p=0.018) remained significant. CONCLUSION This study identified independent predictors of survival in patients irradiated for carcinoma of the urinary bladder and contributes to creation of personalised treatment programs.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lisa Manig
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
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Käsmann L, Bolm L, Schild SE, Janssen S, Rades D. Neutrophil-to-Lymphocyte Ratio Predicts Outcome in Limited Disease Small-cell Lung Cancer. Lung 2017; 195:217-224. [PMID: 28154994 DOI: 10.1007/s00408-017-9976-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/09/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Patients with limited disease small-cell lung cancer (SCLC) receive radiochemotherapy followed by prophylactic cranial irradiation. The prognosis of these patients remains poor with a median survival of 16-24 months. Systemic inflammation was suggested as an important prognostic factor for outcomes. This study investigated the impact of systemic inflammation measured with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at first diagnosis in patients with limited disease SCLC for outcomes. METHODS Data of 65 patients receiving radiochemotherapy for limited disease SCLC were analyzed. NLR and PLR were obtained from blood sample at first diagnosis of SCLC and 12 characteristics including gender, age, ECOG, T-category, N-category, pack years, smoking during radiotherapy, respiratory insufficiency, hemoglobin levels during radiotherapy, radiation dose (<56 vs. ≥56 Gy), concurrent radiochemotherapy, and prophylactic cranial irradiation (PCI) were evaluated for local control, metastasis-free survival, and overall survival. RESULTS Survival rates at 1, 2, and 3 years were 71, 45, and 28%, respectively. Median survival time was 20 months. Independent factors for improved survival were NLR < 4 (p = 0.03), ECOG 0-1 (p = 0.002), and PCI (p = 0.015). Lower T-category was an independent positive factor of local control (p = 0.035). Improved metastasis-free survival was associated with NLR < 4 (p = 0.011), ECOG 0-1 (p = 0.002), N-category 0-1 (p = 0.048), non-smoking during radiotherapy (p = 0.009), and PCI (p = 0.006). CONCLUSION NLR was found to be an independent prognostic factor for overall survival. The evaluation of NLR can help identify patients with poor prognosis and appears a useful prognostic marker in clinical practice. A prospective analysis is warranted to confirm these findings.
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Affiliation(s)
- Lukas Käsmann
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Louisa Bolm
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hanover, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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A New Score for Estimating Survival After Definitive Radiochemotherapy of Limited Disease Small Cell Lung Cancers. Lung 2016; 194:625-9. [PMID: 27140191 DOI: 10.1007/s00408-016-9886-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Most patients with limited disease small cell lung cancer (LD-SCLC) receive definitive radiochemotherapy. Some patients cannot withstand combined modality treatments. Patients with short life expectancies should receive less time-consuming programs. For patients with favorable prognoses, cure while avoiding late toxicity is important. Personalized treatment programs are required. An instrument to estimate the survival after radiochemotherapy of LD-SCLC was created. METHODS Seventy-one patients receiving definitive radiochemotherapy for LD-SCLC were retrospectively analyzed. Eight factors were evaluated for survival including gender, age, Karnofsky performance score, T-stage, N-stage, tumor substage, number of pack years, and pre-radiotherapy hemoglobin level. Factors that were significant (p < 0.05) or showed a trend (p ≤ 0.08) on multivariate analyses were incorporated in the score. Scoring points were derived from 2-year survival rates divided by 10 and added to scores for individual patients. RESULTS On multivariate analysis, gender (p = 0.03), performance score (p < 0.001), and pre-radiotherapy hemoglobin level (p = 0.04) were significant, and tumor substage showed a trend (p = 0.08). Taking into account the 2-year survival rates of these factors, scores for single patients ranged from 9 to 26 points. Three groups were identified: 9-13, 14-18, and 19-26 points. One-year survival rates were 8, 73, and 100 %, respectively (p < 0.001). Two-year survival rates were 0, 35, and 87 %, respectively (p < 0.001). The 3-year survival rates were 0, 19, and 75 %, respectively (p < 0.001). CONCLUSION This score including three groups with significantly different survival rates is a helpful instrument for personalization of therapy for patients with LD-SCLC. When using this instrument, the limitations if this study must be taken into account.
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Burris JL, Studts JL, DeRosa AP, Ostroff JS. Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research. Cancer Epidemiol Biomarkers Prev 2015; 24:1450-61. [PMID: 26282629 PMCID: PMC4592460 DOI: 10.1158/1055-9965.epi-15-0257] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022] Open
Abstract
Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.
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Affiliation(s)
- Jessica L Burris
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Psychology, Lexington, Kentucky.
| | - Jamie L Studts
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Behavioral Science, Lexington, Kentucky
| | - Antonio P DeRosa
- Memorial Sloan Kettering Cancer Center, Medical Library, New York, New York
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, Psychiatry and Behavioral Sciences Service, New York, New York
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White J, Dixon S. Nurse led Patient Education Programme for patients undergoing a lung resection for primary lung cancer. J Thorac Dis 2015; 7:S131-7. [PMID: 25984358 DOI: 10.3978/j.issn.2072-1439.2015.03.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/05/2015] [Indexed: 11/14/2022]
Abstract
There has been an increase in the number of patients undergoing lung resection for primary or suspected primary lung cancer in the UK due to improved staging techniques, dedicated thoracic surgeons and other initiatives such as preoperative pulmonary rehabilitation. This has had an impact on local healthcare resources requiring new ways of delivering thoracic surgical services. When considering service changes, patient reported outcomes are pivotal in terms of ensuring that the experience of care is enhanced and may include elements such as involving patients in their care, reducing the length of inpatient stay and reducing postoperative complications. The implementation of a thoracic surgical Patient Education Programme (PEP) has the potential to address these measures and improve the psychological and physical wellbeing of patients who require a lung resection. It may also assist in their care as an inpatient and to enhance recovery after surgery both in the short and long term.
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Affiliation(s)
- John White
- 1 Lead Macmillan Lung Cancer Nurse Specialist, 2 Macmillan Thoracic Surgical Nurse Specialist, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sandra Dixon
- 1 Lead Macmillan Lung Cancer Nurse Specialist, 2 Macmillan Thoracic Surgical Nurse Specialist, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin 2014; 64:272-90. [PMID: 24817674 PMCID: PMC4377321 DOI: 10.3322/caac.21231] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 01/01/2023] Open
Abstract
Approximately 30% of all cancer deaths in the United States are caused by tobacco use and smoking. Cancers of eighteen sites have been causally linked to smoking, the most common of which are the lung, head and neck, bladder, and esophagus. While quit rates and quit attempt rates are relatively high shortly after a cancer diagnosis, the recidivism rates are also high. Therefore, screening, treating, and preventing relapse to tobacco use is imperative among patients with and survivors of cancer. To date, research has consistently shown that a combination of pharmacologic and behavioral interventions is needed to achieve the highest smoking cessation rates, with a recent emphasis on individualized treatment as a most promising approach. Challenges in health care systems, including the lack of appropriate resources and provider training, have slowed the progress in addition to important clinical considerations relevant to the treatment of tobacco dependence (eg, a high degree of comorbidity with psychiatric disorders and other substance use disorders). However, continued tobacco use has been shown to limit the effectiveness of major cancer treatments and to increase the risk of complications and of developing secondary cancers. The authors recommend that oncology providers screen all patients for tobacco use and refer users to specialized treatment when available. Alternatively, oncology clinicians can provide basic advice on tobacco use cessation and pharmacotherapy and/or referral to outside resources (eg, quitlines). Herein, the authors summarize the current knowledge on tobacco use and its treatment, with a focus on the related available evidence for patients with and survivors of cancer.
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Affiliation(s)
- Maher Karam-Hage
- Associate Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M. Cinciripini
- Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen R. Gritz
- Professor and Chair, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Warren GW, Singh AK. Nicotine and lung cancer. J Carcinog 2013; 12:1. [PMID: 23599683 PMCID: PMC3622363 DOI: 10.4103/1477-3163.106680] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/13/2012] [Indexed: 01/07/2023] Open
Abstract
Tobacco use in cancer patients is associated with increased cancer treatment failure and decreased survival. Nicotine is one of over 7,000 compounds in tobacco smoke and nicotine is the principal chemical associated with addiction. The purpose of this article is to review the tumor promoting activities of nicotine. Nicotine and its metabolites can promote tumor growth through increased proliferation, angiogenesis, migration, invasion, epithelial to mesenchymal transition, and stimulation of autocrine loops associated with tumor growth. Furthermore, nicotine can decrease the biologic effectiveness of conventional cancer treatments such as chemotherapy and radiotherapy. Common mechanisms appear to involve activation of nicotinic acetylcholine receptors and beta-adrenergic receptors leading to downstream activation of parallel signal transduction pathways that facilitate tumor progression and resistance to treatment. Data suggest that nicotine may be an important mechanism by which tobacco promotes tumor development, progression, and resistance to cancer treatment.
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Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA and Roswell Park Cancer Institute, Buffalo, NY, USA ; Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA and Roswell Park Cancer Institute, Buffalo, NY, USA
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de Lima KWA, Guembarovski RL, Oda JMM, Ramos G, Oliveira BV, Cavalli IJ, de Souza Fonseca Ribeiro EM, Gonçalves MSB, Aoki MN, Nunes SOV, Watanabe MAE. Association between the STin2 VNTR polymorphism and smoking behavior in oral cancer patients and healthy individuals. Clin Exp Med 2011; 12:13-9. [PMID: 21626393 DOI: 10.1007/s10238-011-0140-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 05/06/2011] [Indexed: 11/24/2022]
Abstract
The serotonergic system may be involved in smoking behavior since the intake of nicotine increases serotonin secretion in the CNS. Moreover, evidence supporting the beneficial effect of selective serotonin reuptake for quitting smoking suggesting that the serotonin transporter (5-HTT) is a plausible target for the understanding and elucidation of smoking behavior. The transcriptional activity of its human gene (SLC6A4) is modulated by a polymorphism described in the second intron, the STin2 VNTR, which thus may interfere with 5-HTT synthesis. In this study was analyzed the polymorphism STin2 VNTR of 60 smokers male patients diagnosed for oral carcinoma, 61 male smokers without cancer and 65 non-smoker healthy blood donors. The STin2. 9 allele carriers were more present in smoker groups (with cancer and without cancer, respectively) than in the non-smoker (OR = 7.11, 95% CI = 0.83-60.91 and OR = 24.73; IC 95% = 3.17-192.66). Conversely, individuals carrying allele 10 were more prevalent in non-smokers compared with smokers (oral cancer patients and individuals without cancer, respectively), showing a protective factor of this allele (OR = 0.56; 95% CI = 0.24-1.33 and OR = 0.46; 95% CI = 0.20-1.07). This is the first report of a study assessing the importance of STin2 VNTR smoking behavior in Brazilian individuals and the association of STin2. 9 allele carriers in nicotine dependence. It is suggested that individuals with low serotonin concentration in the central nervous system, probably due to the presence of the allele for high expression of 5-HTT,especially STin2. 9, were more susceptible to nicotine dependence. Moreover, individuals with the 10 allele might have less risk for nicotine dependence.
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Affiliation(s)
- Kalil William Alves de Lima
- Biological Science Center, Department of Pathological Sciences, Laboratory of Molecular Genetic and Immunology, State University of Londrina, Campus Universitário, CEP, Londrina, PR, Brazil
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Rades D, Setter C, Dahl O, Schild SE, Noack F. Fibroblast growth factor 2--a predictor of outcome for patients irradiated for stage II-III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2010; 82:442-7. [PMID: 20950963 DOI: 10.1016/j.ijrobp.2010.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. METHODS AND MATERIALS The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. RESULTS On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. CONCLUSIONS Tumor cell expression of FGF-2 appeared to be an independent negative predictor of LRC, MFS, and OS.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, Lubeck, Germany.
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Nguyen SK, Masson-Côté L, Fortin A, Dagnault A. Influence of smoking status on treatment outcomes after post-operative radiation therapy for non-small-cell lung cancer. Radiother Oncol 2010; 96:89-93. [DOI: 10.1016/j.radonc.2010.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 05/07/2010] [Accepted: 05/15/2010] [Indexed: 11/26/2022]
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Prognostic impact of erythropoietin expression and erythropoietin receptor expression on locoregional control and survival of patients irradiated for stage II/III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2010; 80:499-505. [PMID: 20646855 DOI: 10.1016/j.ijrobp.2010.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 02/05/2010] [Accepted: 02/09/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE Prognostic factors can guide the physician in selecting the optimal treatment for an individual patient. This study investigates the prognostic value of erythropoietin (EPO) and EPO receptor (EPO-R) expression of tumor cells for locoregional control and survival in non-small-cell lung cancer (NSCLC) patients. METHODS AND MATERIALS Fourteen factors were investigated in 62 patients irradiated for stage II/III NSCLC, as follows: age, gender, Karnofsky performance score (KPS), histology, grading, TNM/American Joint Committee on Cancer (AJCC) stage, surgery, chemotherapy, pack years (average number of packages of cigarettes smoked per day multiplied by the number of years smoked), smoking during radiotherapy, hemoglobin levels during radiotherapy, EPO expression, and EPO-R expression. Additionally, patients with tumors expressing both EPO and EPO-R were compared to those expressing either EPO or EPO-R and to those expressing neither EPO nor EPO-R. RESULTS On univariate analysis, improved locoregional control was associated with AJCC stage II cancer (p < 0.048), surgery (p < 0.042), no smoking during radiotherapy (p = 0.024), and no EPO expression (p = 0.001). A trend was observed for a KPS of >70 (p = 0.08), an N stage of 0 to 1 (p = 0.07), and no EPO-R expression (p = 0.10). On multivariate analysis, AJCC stage II and no EPO expression remained significant. No smoking during radiotherapy was almost significant. On univariate analysis, improved survival was associated with N stage 0 to 1 (p = 0.009), surgery (p = 0.039), hemoglobin levels of ≥12 g/d (p = 0.016), and no EPO expression (p = 0.001). On multivariate analysis, N stage 0 to 1 and no EPO expression maintained significance. Hemoglobin levels of ≥12 g/d were almost significant. On subgroup analyses, patients with tumors expressing both EPO and EPO-R had worse outcomes than those expressing either EPO or EPO-R and those expressing neither EPO nor RPO-R. CONCLUSIONS EPO expression of tumor cells was an independent prognostic factor for locoregional control and survival in patients irradiated for NSCLC. EPO-R expression showed a trend. Patients with tumors expressing both EPO and EPO-R have an unfavorable prognosis.
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Prognostic Impact of VEGF and VEGF Receptor 1 (FLT1) Expression in Patients Irradiated for Stage II/III Non-Small Cell Lung Cancer (NSCLC). Strahlenther Onkol 2010; 186:307-14. [DOI: 10.1007/s00066-010-2131-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/16/2010] [Indexed: 12/12/2022]
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Schnoll RA, Martinez E, Tatum KL, Weber DM, Kuzla N, Glass M, Ridge JA, Langer C, Miyamoto C, Wileyto EP, Leone F. A bupropion smoking cessation clinical trial for cancer patients. Cancer Causes Control 2010; 21:811-20. [PMID: 20087643 DOI: 10.1007/s10552-010-9507-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/06/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Many cancer patients continue to smoke post diagnosis, yet there have been few smoking cessation trials for this population. Depression, which is prevalent among cancer patients, may be a barrier to cessation. METHODS This double-blind placebo-controlled trial randomized 246 cancer patients to 9 weeks of placebo or bupropion, stratifying by pre-treatment depression symptoms. In addition, all patients received transdermal nicotine and behavioral counseling. Primary outcomes were 7-day point-prevalence abstinence, biochemically confirmed, at the end of treatment (Week 12), and at 6 months post quit day (Week 27). Additional outcomes included: withdrawal, affect, quality of life, compliance, and side effects. RESULTS There was no main effect of bupropion vs. placebo on abstinence (Odds Ratio [OR] = 1.36, 95% CI: 0.38-4.81, p = .64). Patients with depression symptoms reported significantly lower abstinence rates vs. patients without depression symptoms (OR = .14, 95% CI: 0.02-0.80, p = .03). Bupropion increased abstinence rates, vs. placebo, more for participants with depression vs. those without depression symptoms. For patients with depression symptoms, bupropion reduced withdrawal symptoms and improved quality of life vs. placebo. CONCLUSIONS For patients with depression symptoms, bupropion increases abstinence rates, lowers withdrawal, and increases quality of life. However, abstinence rates among patients with depression symptoms were low vs. patients without depression symptoms, who exhibited similar abstinence rates when treated with bupropion or transdermal nicotine and counseling alone. These results can guide future smoking cessation intervention studies with cancer patients.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA.
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Lawenda BD, Blumberg JB. Response: Re: Should Supplemental Antioxidant Administration Be Avoided During Chemotherapy and Radiation Therapy? J Natl Cancer Inst 2009. [DOI: 10.1093/jnci/djn447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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