1
|
Cooley-Rieders K, Glenn C, Van Haren RM, Salfity H, Starnes SL. A decade of surgical outcomes in a structured lung cancer screening program. J Thorac Cardiovasc Surg 2023; 166:1245-1253.e1. [PMID: 36858845 DOI: 10.1016/j.jtcvs.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lung cancer screening can decrease mortality. The majority of screen-detected cancers are early stage and undergo surgical resection. However, there are little data regarding the outcomes of surgical treatment outside of clinical trials. The purpose of this study was to compare the outcomes of curative resection for screen-detected lung cancers with nonscreened, incidentally detected cancers at an institution with a structured screening program. METHODS Patients undergoing lung cancer curative resection from January 2012 to June 2021 were identified from a prospective database. Baseline patient characteristics, tumor characteristics, and outcomes were compared between cancer detected from screening and cancer detected incidentally. RESULTS There were 199 patients in the incidental group and 82 patients in the screened group. Mean follow-up was 33.3 ± 25 months. The screened group had more African Americans (P = .04), a higher incidence of emphysema (P = .02), less prior cancers (P < .01), and more pack-years smoked (P < .01). The screened group had a smaller size (1.74 vs 2.31 cm, P < .01); however, pathologic stage was similar, with the majority being stage I. Postoperative morbidity, 30-day mortality, and overall and recurrence-free survival were similar between groups. Only 48.7% of the incidental group met current US Preventative Services Task Force screening criteria (age 50-80 years, ≥20 pack-year smoking history). CONCLUSIONS Screen-detected lung cancers have excellent postoperative and long-term outcomes with curative resection, similar to incidentally detected cancers. A large portion of incidentally detected lung cancers do not meet current screening guidelines, which is an opportunity for further refinement of eligibility.
Collapse
Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carter Glenn
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| |
Collapse
|
2
|
Sung MR, Tomasini P, Le LW, Kamel-Reid S, Tsao MS, Liu G, Bradbury PA, Shepherd FA, Li JJ, Feld R, Leighl NB. Effects of Ethnicity on Outcomes of Patients With EGFR Mutation–Positive NSCLC Treated With EGFR Tyrosine Kinase Inhibitors and Surgical Resection. JTO Clin Res Rep 2022; 3:100259. [PMID: 35112092 PMCID: PMC8790496 DOI: 10.1016/j.jtocrr.2021.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/09/2022] Open
|
3
|
Emmerick ICM, Singh A, Powers M, Lou F, Lin P, Maxfield M, Uy K. Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis. Rev Saude Publica 2021; 55:112. [PMID: 34932701 PMCID: PMC8664062 DOI: 10.11606/s1518-8787.2021055003345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To present the overall survival rate for lung cancer and identify the factors associated with early diagnosis of stage I and II lung cancer. METHODS This is a retrospective cohort study including individuals diagnosed with lung cancer, from January 2009 to December 2017, according to the cancer registry at UMass Memorial Medical Center. Five-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. Factors associated with diagnosing clinical stage I and II lung cancer were identified by bivariate and multivariate backward stepwise logistic regression (Log-likelihood ratio (LR)) at 95% confidence interval (CI). RESULTS The study was conducted with data on 2730 individuals aged 67.9 years on average, 51.5% of whom female, 92.3% white, and 6.6% never smoked. Five-year overall survival was 21%. Individuals diagnosed with early-stage disease had a 43% five-year survival rate compared to 8% for those diagnosed at late stages. Stage at diagnosis was the main factor associated with overall survival [HR = 4.08 (95%CI: 3.62-4.59)]. Factors associated with early diagnosis included patients older than 68 years [OR = 1.23 (95%CI: 1.04-1.45)], of the female gender [OR = 1.47 (95%CI: 1.24-1.73)], white [OR = 1.63 (95%CI: 1.16-2.30)], and never-smokers [OR = 1.37 (95%CI: 1.01-1.86)]; as well as tumors affecting the upper lobe [OR = 1.46 (95%CI: 1.24-1.73)]; adenocarcinoma [OR = 1.43 (95%CI: 1.21-1.69)]; and diagnosis after 2014 [OR = 1.61 (95%CI: 1.37-1.90)]. CONCLUSIONS Stage at diagnosis was the most decisive predictor for survival. Non-white and male individuals were more likely to be diagnosed at a late stage. Thus, promoting lung cancer early diagnosis by improving access to health care is vital to enhance overall survival for individuals with lung cancer.
Collapse
Affiliation(s)
| | - Anupama Singh
- University of Massachusetts Medical School. Worcester, Massachusetts, USA
| | - Maggie Powers
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Feiran Lou
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Poliana Lin
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Mark Maxfield
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| | - Karl Uy
- University of Massachusetts Medical School. Division of Thoracic Surgery. Department of Surgery. Worcester, Massachusetts, USA
| |
Collapse
|
4
|
Mitchell KG, Bostock IC, Antonoff MB. Social Disparities in Thoracic Surgery Database Research: Implications and Impact. Thorac Surg Clin 2021; 32:83-90. [PMID: 34801199 DOI: 10.1016/j.thorsurg.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A complex relationship exists between health care disparities and large databases among the thoracic surgical patient population. Using the example of thoracic malignancies, the ability of investigations leveraging large databases and novel analytical approaches to highlight disparate access to care and discordant outcomes following treatment is illustrated. Large, widely used databases may not be representative of the thoracic surgical patient population as a whole, and caution must be used when interpreting and generalizing results gleaned from such database analyses. Ensuring appropriate representation of all relevant patient subgroups in research databases will improve external generalizability and scientific validity of future investigations.
Collapse
Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA
| | - Ian C Bostock
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA.
| |
Collapse
|
5
|
Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population. Chest 2020; 158:2200-2210. [DOI: 10.1016/j.chest.2020.05.592] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
|
6
|
Varlotto JM, Emmerick I, Voland R, DeCamp MM, Flickinger JC, Maddox DJ, Herbert C, Griffin M, Rava P, Fitzgerald TJ, Oliveira P, Baima J, Sood R, Walsh W, McIntosh LJ, Lou F, Maxfield M, Rassaei N, Uy K. The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management. Front Oncol 2020; 10:417. [PMID: 32528866 PMCID: PMC7264374 DOI: 10.3389/fonc.2020.00417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR). Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR excluding those with any preoperative chemotherapy and/or radiation, follow-up <3 months, stage IV disease, or >1 tumor nodule. Multivariable modeling (MVA) was used to determine factors associated with overall survival (OS). Propensity score matching (PSM) was used to determine preoperative risk factors for pN+ in patients having at least one node examined to assess radiation's effect on OS in those patients with pN+ and to determine whether SLR was associated with inferior OS as compared to lobectomy for each nodal stage. Results: A total of 40,202 patients underwent SLR, but only 58.3% had one lymph node examined. Then, 2,615 individuals had pN+ which decreased progressively from 15.1% in 2004 to 8.9% in 2014 (N1, from 6.3 to 3.0%, and N2, from 8.4 to 5.9%). A lower risk of pN+ was noted for squamous cell carcinomas, bronchioloalveolar adenocarcinoma (BAC), adenocarcinomas, and right upper lobe locations. In the pN+ group, OS was worse without chemotherapy or radiation. Radiation was associated with a strong trend for OS in the entire pN+ group (p = 0.0647) which was largely due to the effects on those having N2 disease (p = 0.009) or R1 resections (p = 0.03), but not N1 involvement (p = 0.87). PSM noted that SLR was associated with an inferior OS as compared to lobectomy by nodal stage in the overall patient population and even for those with tumors <2 cm. Conclusion: pN+ incidence in SLRs has decreased over time. SLR was associated with inferior OS as compared to lobectomy by nodal stage. Radiation appears to improve the OS in patients undergoing SLR with pN+, especially in those with N2 nodal involvement and/or positive margins.
Collapse
Affiliation(s)
- John M Varlotto
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Isabel Emmerick
- University of Massachusetts Medical School, Worcester, MA, United States.,Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Rick Voland
- School of Nursing, University of Wisconsin, Madison, WI, United States
| | - Malcom M DeCamp
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Debra J Maddox
- Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Christine Herbert
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Molly Griffin
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Paul Rava
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Thomas J Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Paulo Oliveira
- University of Massachusetts Medical School, Worcester, MA, United States.,Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United States
| | - Jennifer Baima
- Department of Orthopedics and Rehabilitation, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Rahul Sood
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United States
| | - William Walsh
- University of Massachusetts Medical School, Worcester, MA, United States.,Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Lacey J McIntosh
- University of Massachusetts Medical School, Worcester, MA, United States.,Department of Radiology, University of Massachusetts, Worcester, MA, United States
| | - Feiran Lou
- University of Massachusetts Medical School, Worcester, MA, United States.,Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Mark Maxfield
- University of Massachusetts Medical School, Worcester, MA, United States.,Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Negar Rassaei
- Department of Pathology, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Karl Uy
- University of Massachusetts Medical School, Worcester, MA, United States.,Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| |
Collapse
|
7
|
Corsini EM, Wang J, Wu CC, Fujimoto J, Negrao MV, Chen R, Quek K, Mitchell KG, Chow CWB, Little L, Gumbs C, Song X, Behrens C, Correa AM, Antonoff MB, Swisher SG, Heymach JV, Zhang J, Wistuba II, Futreal PA, Sepesi B, Zhang J. Genomic assessment distinguishes intrapulmonary metastases from synchronous primary lung cancers. J Thorac Dis 2020; 12:1952-1959. [PMID: 32642098 PMCID: PMC7330333 DOI: 10.21037/jtd-20-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Multiple synchronous lung tumors (MSLT), particularly within a single lobe, represent a diagnostic and treatment challenge. While histologic assessment was once the only method to possibly distinguish multiple primary lung cancers, there is a growing interest in identifying unique genomic features or mutations to best characterize these processes. Methods In order to differentiate multiple primary lung malignancies from intrapulmonary metastases in patients with MSLT, we performed whole exome sequencing (WES) on 10 tumor samples from 4 patients with MSLT. Results Shared mutations between tumors from the same patient varied from 0-91%. Patient 3 shared no common mutations; however, in Patients 2 and 4, identical mutations were identified among all tumors from each patient, suggesting that the three tumors identified in Patient 3 represent separate primary lung cancers, while those of Patients 1, 2 and 4 signify hematogenous and lymphatic spread. Conclusions A high proportion of shared mutations between different lung tumors is likely indicative of intrapulmonary metastatic disease, while tumors with distinct genomic profiles likely represent multiple primary malignancies driven by distinct molecular events. Application of genomic profiling in the clinical setting may prove to be important to precise management of patients with MSLT.
Collapse
Affiliation(s)
- Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinliang Wang
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Medical Oncology, Chinese PLA General Hospital, Beijing 100853, China
| | - Chia-Chin Wu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Junya Fujimoto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcelo V Negrao
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Runzhe Chen
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly Quek
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi-Wan B Chow
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Latasha Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Behrens
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
8
|
Percac-Lima S, Ashburner JM, Atlas SJ, Rigotti NA, Flores EJ, Kuchukhidze S, Park ER. Barriers to and Interest in Lung Cancer Screening Among Latino and Non-Latino Current and Former Smokers. J Immigr Minor Health 2020; 21:1313-1324. [PMID: 30701427 DOI: 10.1007/s10903-019-00860-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is a leading cause of cancer death in Latinos. In a telephone survey, we assessed perceptions about lung cancer and awareness of, interest in, and barriers to lung screening among older current and former smokers. We compared Latino and non-Latino responses adjusting for age, sex, education, and smoking status using logistic regression models. Of the 460 patients who completed the survey (51.5% response rate), 58.0% were women, 49.3% former smokers, 15.7% Latino, with mean age 63.6 years. More Latinos believed that lung cancer could be prevented compared to non-Latinos (74.6% vs. 48.2%, OR 3.07, CI 1.89-5.01), and less worried about developing lung cancer (34.8% vs. 50.3%, OR 0.44, CI 0.27-0.72). Most participants were not aware of lung screening (44.1% Latinos vs. 34.3% Non-Latinos, OR 1.24, CI 0.79-1.94), but when informed, more Latinos wanted to be screened (90.7% vs. 67%, OR 4.58, CI 2.31-9.05). Latinos reported fewer barriers to lung screening.
Collapse
Affiliation(s)
- Sanja Percac-Lima
- Division of General Internal Medicine Massachusetts General Hospital, 100 Cambridge Street, Suite 1647, 02114, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Mongan Institute for Health Policy Center Massachusetts General Hospital, Boston, MA, USA.
| | - Jeffrey M Ashburner
- Division of General Internal Medicine Massachusetts General Hospital, 100 Cambridge Street, Suite 1647, 02114, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine Massachusetts General Hospital, 100 Cambridge Street, Suite 1647, 02114, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute for Health Policy Center Massachusetts General Hospital, Boston, MA, USA
| | - Nancy A Rigotti
- Division of General Internal Medicine Massachusetts General Hospital, 100 Cambridge Street, Suite 1647, 02114, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute for Health Policy Center Massachusetts General Hospital, Boston, MA, USA
| | - Efren J Flores
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Department of Radiology, Boston, MA, USA
| | | | - Elyse R Park
- Harvard Medical School, Boston, MA, USA
- Mongan Institute for Health Policy Center Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Percac-Lima S, Ashburner JM, Rigotti NA, Park ER, Chang Y, Kuchukhidze S, Atlas SJ. Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Med 2018; 7:894-902. [PMID: 29464877 PMCID: PMC5852345 DOI: 10.1002/cam4.1297] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 12/14/2022] Open
Abstract
Annual chest computed tomography (CT) can decrease lung cancer mortality in high-risk individuals. Patient navigation improves cancer screening rates in underserved populations. Randomized controlled trial was conducted from February 2016 to January 2017 to evaluate the impact of a patient navigation program on lung cancer screening (LCS) among current smokers in five community health centers (CHCs) affiliated with an academic primary care network. We randomized 1200 smokers aged 55-77 years to intervention (n = 400) or usual care (n = 800). Navigators contacted patients to determine LCS eligibility, introduce shared decision making about screening, schedule appointments with primary care physicians (PCPs), and help overcome barriers to obtaining screening and follow-up. Control patients received usual care. The main outcome was the proportion of patients who had any chest CT. Secondary outcomes were the proportion of patients contacted, proportion receiving LCS CTs, screening results and number of lung cancers diagnosed. Of the 400 intervention patients, 335 were contacted and 76 refused participation. Of the 259 participants, 124 (48%) were ineligible for screening; 119 had smoked <30 pack-years, and five had competing comorbidities. Among the 135 eligible participants in the intervention group, 124 (92%) had any chest CT performed. In intention-to-treat analyses, 124 intervention patients (31%) had any chest CT versus 138 control patients (17.3%, P < 0.001). LCS CTs were performed in 94 intervention patients (23.5%) versus 69 controls (8.6%, P < 0.001). A total of 20% of screened patients required follow-up. Lung cancer was diagnosed in eight intervention (2%) and four control (0.5%) patients. A patient navigation program implemented in CHCs significantly increased LCS among high-risk current smokers.
Collapse
Affiliation(s)
- Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jeffrey M Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Shroyer AL, Quin JA, Grau-Sepulveda MV, Kosinski AS, Yerokun BA, Mitchell JD, Bilfinger TV. Geographic Variations in Lung Cancer Lobectomy Outcomes: The General Thoracic Surgery Database. Ann Thorac Surg 2017; 104:1650-1655. [DOI: 10.1016/j.athoracsur.2017.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 01/10/2023]
|
11
|
Stern MC, Fejerman L, Das R, Setiawan VW, Cruz-Correa MR, Perez-Stable EJ, Figueiredo JC. Variability in Cancer Risk and Outcomes Within US Latinos by National Origin and Genetic Ancestry. CURR EPIDEMIOL REP 2016; 3:181-190. [PMID: 27547694 PMCID: PMC4978756 DOI: 10.1007/s40471-016-0083-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Latinos have lower rates for most common cancer sites and higher rates of some less common cancers (gallbladder, liver, gastric, and cervical) than other ethnic/racial groups. Latinos are a highly heterogeneous population with diverse national origins, unique genetic admixture patterns, and wide spectrum of socio-demographic characteristics. Across the major cancers (breast, colorectal, prostate, lung, and liver) US-born Latinos have higher incidence and worse survival than foreign-born, and those with low-socioeconomic status have the lowest incidence. Puerto Rican and Cuban Latinos have higher incidence rates than Mexican Latinos. We have identified the following themes as understudied and critical to reduce the cancer burden among US Latinos: (1) etiological studies considering key sources of heterogeneity, (2) culturally sensitive cancer prevention strategies, (3) description of the molecular tumor landscape to guide treatments and improve outcomes, and (4) development of prediction models of disease risk and outcomes accounting for heterogeneity of Latinos.
Collapse
Affiliation(s)
- Mariana C. Stern
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Laura Fejerman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA USA
| | - Rina Das
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - V. Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Marcia R. Cruz-Correa
- Department of Medicine and Biochemistry, University of Puerto Rico Medical Sciences Campus and University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Eliseo J. Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Jane C. Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
12
|
Hudson J, Munoz-Antonia T, Haura E, Cress D, Simmons VN, Quinn GP. Translating Hispanic Genomic Factors in Lung Cancer Into Clinical Practice: EGFR Testing for Improved Outcomes. ACTA ACUST UNITED AC 2016; 3. [PMID: 29888762 PMCID: PMC5990038 DOI: 10.17795/gct-35961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Janella Hudson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States
| | - Teresita Munoz-Antonia
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States
| | - Eric Haura
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States.,Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, United States
| | - Doug Cress
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States.,Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, United States
| | - Gwendolyn P Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States.,Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, United States
| |
Collapse
|