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Candal-Pedreira C, Ruano-Ravina A, Calvo de Juan V, Cobo M, Cantero A, Rodríguez-Abreu D, Estival A, Carcereny E, Hernandez A, López Castro R, Medina A, García Campelo R, Fernández Bruno M, Barnabé R, Bosch-Barrera J, Massutí B, Dómine M, Camps C, Ortega AL, Provencio M. Analysis of Diagnostic Delay and its Impact on Lung Cancer Survival: Results From the Spanish Thoracic Tumor Registry. Arch Bronconeumol 2024:S0300-2896(24)00268-0. [PMID: 39068056 DOI: 10.1016/j.arbres.2024.07.006] [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: 05/28/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Early detection is crucial to improve lung cancer survival rates. Delays in diagnosis might negatively impact the prognosis of the disease. This study aims to analyze the diagnostic delay in lung cancer patients and describe if there is an association between delay and survival. METHODS The data source used was the Thoracic Tumor Registry of the Spanish Lung Cancer Group. This analysis was restricted to lung cancer cases with information on the first date of consultation by symptoms and date of diagnosis. The delay was calculated as the number of days between the two dates. A descriptive analysis was performed, and ordinal logistic regressions were fitted with delay as the dependent variable. Kaplan-Meier survival analysis and Cox regression were performed. RESULTS 22,755 lung cancer cases were included. Never smokers were 1.16 (95%CI: 1.06-1.27) times more likely to register longer delay than smokers. Stage 0-I-II cases had a 3.09 (95%CI: 2.88-3.32) higher risk of longer delay compared to III-IV stages. Overall, 5-year survival rate after diagnosis was 23.64% (95%CI: 22.88-24.41). In those categorized as having the shortest delay 5-year survival was 17.67% (95%CI: 16.31-19.07) and in the extreme delay it was 32.98% (95%CI: 31.28-34.69) (p<0.001). Adjusted mortality risk was higher in those with the shortest delay (HR 1.36, CI95%: 1.30-1.43) in comparison with the extreme delay. CONCLUSIONS Diagnostic delay is short among Spanish lung cancer patients, indicating a relatively quick diagnostic process. Extreme delays appear to be associated with higher survival rates, possibly attributed to slow-growing tumors, earlier stage at diagnosis or basically the natural history of this disease.
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Affiliation(s)
- Cristina Candal-Pedreira
- Area of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Spanish Lung Cancer Group, Spain
| | - Alberto Ruano-Ravina
- Area of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Spanish Lung Cancer Group, Spain.
| | - Virginia Calvo de Juan
- Spanish Lung Cancer Group, Spain; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Manuel Cobo
- Spanish Lung Cancer Group, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Alexandra Cantero
- Spanish Lung Cancer Group, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Delvys Rodríguez-Abreu
- Spanish Lung Cancer Group, Spain; Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Anna Estival
- Spanish Lung Cancer Group, Spain; Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Enric Carcereny
- Spanish Lung Cancer Group, Spain; Institut Català D'Oncologia Badalona - Hospital Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Ainhoa Hernandez
- Spanish Lung Cancer Group, Spain; Institut Català D'Oncologia Badalona - Hospital Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Rafael López Castro
- Spanish Lung Cancer Group, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Andrea Medina
- Spanish Lung Cancer Group, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rosario García Campelo
- Spanish Lung Cancer Group, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Manuel Fernández Bruno
- Spanish Lung Cancer Group, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Reyes Barnabé
- Spanish Lung Cancer Group, Spain; Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Joaquim Bosch-Barrera
- Spanish Lung Cancer Group, Spain; Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta and Precision Oncology Group (OncoGIR-Pro), Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
| | - Bartomeu Massutí
- Spanish Lung Cancer Group, Spain; Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | - Manuel Dómine
- Spanish Lung Cancer Group, Spain; Hospital Universitario Fundación Jiménez Díaz. IIS-FJD, Madrid, Spain
| | - Carlos Camps
- Spanish Lung Cancer Group, Spain; Hospital General Universitario de Valencia, Valencia, Spain
| | - Ana Laura Ortega
- Spanish Lung Cancer Group, Spain; Hospital Universitario de Jaén, Jaén, Spain
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Ulrich CM, Ratcliffe SJ, Hochheimer CJ, Zhou Q, Huang L, Gordon T, Knafl K, Richmond T, Schapira MM, Miller V, Mao JJ, Naylor M, Grady C. Informed Consent among Clinical Trial Participants with Different Cancer Diagnoses. AJOB Empir Bioeth 2024; 15:165-177. [PMID: 37921867 DOI: 10.1080/23294515.2023.2262992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
IMPORTANCE Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials. OBJECTIVE To examine cancer clinical trial (CCT) participants' perceptions of informed consent processes and variations in perceptions by cancer type. DESIGN AND SETTING AND PARTICIPANTS Cross-sectional survey from mixed-methods study at National Cancer Institute-designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic malignancies, lung cancer, and breast or gynecological cancer (N = 334). MAIN OUTCOME MEASURES Percentages satisfied with consent process and information provided; and assessing participation's perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type. RESULTS Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did-47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT. CONCLUSIONS AND RELEVANCE Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making.
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Affiliation(s)
- Connie M Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Qiuping Zhou
- George Washington University, Washington, District of Columbia, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Thomas Gordon
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kathleen Knafl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Therese Richmond
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Marilyn M Schapira
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Victoria Miller
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Naylor
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christine Grady
- National Institutes of Health, Clinical Center Department of Bioethics, Bethesda, Maryland, USA
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Zhang G, Lu S, Ren Z, Wei L, Chen C, Tao P, Pan X. SIRT2 as a Potential Biomarker in Lung Adenocarcinoma: Implications for Immune Infiltration. Mol Biotechnol 2024:10.1007/s12033-024-01198-3. [PMID: 38902578 DOI: 10.1007/s12033-024-01198-3] [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: 01/03/2024] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
SIRT2 play important roles in cell cycle and cellular metabolism in the development of non-small cell lung cancer (NSCLC), and SIRT2 exhibits its therapeutic effect on NSCLC tumors with high expression of SIRT2. Nevertheless, the clinical relevance of SIRT2 in lung adenocarcinoma (LUAD), particularly its impact on tumor growth and prognostic implications, remains obscure. This investigation entailed a comprehensive analysis of SIRT2 mRNA and protein expression levels in diverse tumor and corresponding healthy tissues, utilizing databases such as TIMER 2.0, UALCAN, and HPA. Prognostic correlations of SIRT2 expression in LUAD patients, stratified by distinct clinicopathological characteristics, were evaluated using the KM Plotter database. Additionally, the TCGA and TIMER 2.0 databases were employed to assess the relationship between SIRT2 and immune infiltration, as well as to calculate immunity, stromal, and estimation scores, thus elucidating the role of SIRT2 in modulating tumor immunotherapy responses. Furthermore, Gene Set Enrichment Analysis (GSEA) was utilized to elucidate SIRT2's biological functions in pan-cancer cells. Our findings revealed a marked reduction in both mRNA and protein levels of SIRT2 in LUAD tumors relative to healthy tissue. Survival analysis indicated that diminished SIRT2 expression correlates with adverse prognostic outcomes in LUAD. Furthermore, SIRT2 expression demonstrated a significant association with various clinicopathologic attributes of LUAD patients, influencing survival outcomes across different clinicopathologic states. Functional enrichment analyses highlighted SIRT2's involvement in cell cycle regulation and immune response. Notably, SIRT2 exhibited a positive correlation with immune cell infiltration, including natural killer (NK) cells, macrophages, and dendritic cells (DCs). In summary, SIRT2 was a potential prognostic biomarker for LUAD and and a new immunotherapy target.
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Affiliation(s)
- Guining Zhang
- Department of Scientific Research, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Shuyu Lu
- Department of Anaesthesia, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxue East Road, Xixiangtang District, Nanning, 530007, Guangxi, China
| | - Zhiling Ren
- Department of Mental Health, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Lijuan Wei
- Graduate School, Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Chunxi Chen
- Graduate School, Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Pinyue Tao
- Department of Anaesthesia, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxue East Road, Xixiangtang District, Nanning, 530007, Guangxi, China.
| | - Xiao Pan
- The Second Ward of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxue East Road, Xixiangtang District, Nanning, 530007, Guangxi, China.
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Sætre LMS, Raasthøj I, Lauridsen GB, Balasubramaniam K, Haastrup P, Rasmussen S, Eilerskov N, Søndergaard J, Storsveen MM, Wehberg S, Jarbøl DE. Revisiting the symptom iceberg based on the Danish symptom cohort - Symptom experiences and healthcare-seeking behaviour in the general Danish population in 2022. Heliyon 2024; 10:e31090. [PMID: 38803940 PMCID: PMC11128908 DOI: 10.1016/j.heliyon.2024.e31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Healthcare-seeking behaviour may change over time, and some groups are more likely to avoid relevant help seeking, which possibly contributes to social inequity in health. Thus, we developed an expansion of and follow-up to the Danish Symptom Cohort (DaSC) from 2012 and formed the DaSC II, which encompassed a population-based questionnaire study investigating symptoms and healthcare-seeking behaviour. In this paper, we describe the conceptual framework, development and content validity of the questionnaire and a responder analysis of the participants in the DaSC II. We present the symptom iceberg in the Danish general population by estimating the prevalence of symptoms and proportion of contacts to general practitioners (GPs) in 2022. Moreover, we discuss differences in healthcare-seeking behaviour with reference to the 2012 DaSC. Methods 100,000 randomly selected Danish citizens aged ≥20 years, along with the 44,713 respondents from the 2012 cohort, were invited to participate in a survey. The questionnaire was pilot and field tested prior to distribution. Descriptive statistics were used to estimate symptom prevalence and proportion of GP contacts, and to execute the respondent analysis. Results Nine out of ten respondents reported at least one symptom within the preceding four weeks and reported an average of 4.6 symptoms. One in four symptoms were presented to a GP. The highest proportion of GP contacts was found for haematuria (63.3 %) and shortness of breath (51.8 %). For several symptoms, differences between the sexes were found in relation to both prevalence and GP contacts. The proportion of GP contacts was higher in 2022 than in 2012 and was most pronounced for general, frequently experienced symptoms and to a lesser extent for cancer alarm symptoms. Conclusion Many symptoms go unreported, which may delay relevant diagnosis; more research on certain symptom categories and population subgroups is needed. Future studies based on the DaSC II form a basis for interventions targeting symptom awareness, healthcare-seeking behaviour and social equity in society and health.
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Affiliation(s)
- Lisa Maria Sele Sætre
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Isabella Raasthøj
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Gitte Bruun Lauridsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Peter Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Natasja Eilerskov
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Maria Munch Storsveen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusej 55, 5230, Odense M, Denmark
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Li Q, Wang T, Tang Y, Zou X, Shen Z, Tang Z, Zhou Y, Shi J. A novel prognostic signature based on smoking-associated genes for predicting prognosis and immune microenvironment in NSCLC smokers. Cancer Cell Int 2024; 24:171. [PMID: 38750571 PMCID: PMC11094918 DOI: 10.1186/s12935-024-03347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/27/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND As a highly heterogeneous tumor, non-small cell lung cancer (NSCLC) is famous for its high incidence and mortality worldwide. Smoking can cause genetic changes, which leading to the occurrence and progress of NSCLC. Nevertheless, the function of smoking-related genes in NSCLC needs more research. METHODS We downloaded transcriptome data and clinicopathological parameters from Gene Expression Omnibus (GEO) databases, and screened smoking-related genes. Lasso regression were applied to establish the 7-gene signature. The associations between the 7-gene signature and immune microenvironment analysis, survival analysis, drug sensitivity analysis and enriched molecular pathways were studied. Ultimately, cell function experiments were conducted to research the function of FCGBP in NSCLC. RESULTS Through 7-gene signature, NSCLC samples were classified into high-risk group (HRG) and low-risk group (LRG). Significant difference in overall survival (OS) between HRG and LRG was found. Nomograms and ROC curves indicated that the 7-gene signature has a stable ability in predicting prognosis. Through the analysis of immune microenvironment, we found that LRG patients had better tumor immune activation. FCGBP showed the highest mutation frequency among the seven prognostic smoking related genes (LRRC31, HPGD, FCGBP, SPINK5, CYP24A1, S100P and FGG), and was notable down-regulated in NSCLC smokers compared with non-smoking NSCLC patients. The cell experiments confirmed that FCGBP knockdown promoting proliferation, migration, and invasion in NSCLC cells. CONCLUSION This smoking-related prognostic signature represents a promising tool for assessing prognosis and tumor microenvironment in smokers with NSCLC. The role of FCGBP in NSCLC was found by cell experiments, which can be served as diagnostic biomarker and immunotherapy target for NSCLC.
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Affiliation(s)
- Qixuan Li
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Tianyi Wang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Yijie Tang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Xian Zou
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Zhongqi Shen
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Zixin Tang
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Youlang Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China.
| | - Jiahai Shi
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China.
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China.
- School of Public Health, Nantong University, Nantong, Jiangsu, 226001, China.
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Quillet A, Le Stang N, Meriau N, Isambert N, Defossez G. Socio-demographic inequalities in stage at diagnosis of lung cancer: A French population-based study. Cancer Epidemiol 2024; 89:102522. [PMID: 38237387 DOI: 10.1016/j.canep.2024.102522] [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] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Diagnosing patients at a non-advanced stage has become a mainstay of lung cancer prevention and control strategies. Understanding socio-demographic inequalities in stage at diagnosis may improve the targeting of interventions on patients at higher risk. This study aimed to identify these socio-demographic determinants in a large-scale French population-based cancer registry. METHODS All incident lung cancers diagnosed between 2008 and 2019 identified from the Poitou-Charentes Cancer Registry (south-west France) were included. Stage at diagnosis was categorised as advanced/non-advanced (TNM III/IV vs I/II) according to the 8th TNM edition, the objective being to ensure a consistent level of prognosis over time. Socio-demographic variables included age, sex, the French European Deprivation Index (EDI) and patient's place of residence. Their impact on stage at diagnosis was quantified by multivariate logistic regression models with subgroup analyses by histological subtype. RESULTS Out of the 15,487 included patients, 75% were diagnosed at an advanced stage (66% to 95% depending on the histological subtype), 17% at a non-advanced stage and 10% at a non-specified stage. Multivariate analysis showed different patterns according to histological subtypes. In patients with adenocarcinoma, a higher risk of advanced stage was found for younger and older patients (u-shape), those most deprived, and those living in rural areas. The same effect of age was reported for squamous cell carcinomas, while no association was found for small-cell lung carcinomas. CONCLUSIONS This study highlighted substantial socio-demographic inequalities in stage at diagnosis, specifically for adenocarcinoma patients. Diagnosis strategies could be refined and strengthened in the non-smoker population, in which adenocarcinomas are mainly reported.
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Affiliation(s)
- Alexandre Quillet
- CHU de Poitiers, Service D'Information Médicale, F-86000 Poitiers, France; Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France.
| | - Nolwenn Le Stang
- Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
| | - Nicolas Meriau
- CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
| | - Nicolas Isambert
- CHU de Poitiers, Service D'Oncologie Médicale, F-86000 Poitiers, France; Université de Poitiers, CIC-INSERM, Axe THOR, F-86000 Poitiers, France
| | - Gautier Defossez
- Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
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Najafiyan B, Bokaii Hosseini Z, Esmaelian S, Firuzpour F, Rahimipour Anaraki S, Kalantari L, Hheidari A, Mesgari H, Nabi-Afjadi M. Unveiling the potential effects of resveratrol in lung cancer treatment: Mechanisms and nanoparticle-based drug delivery strategies. Biomed Pharmacother 2024; 172:116207. [PMID: 38295754 DOI: 10.1016/j.biopha.2024.116207] [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: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/03/2024] Open
Abstract
Lung cancer ranks among the most prevalent forms of cancer and remains a significant factor in cancer-related mortality across the world. It poses significant challenges to healthcare systems and society as a whole due to its high incidence, mortality rates, and late-stage diagnosis. Resveratrol (RV), a natural compound found in various plants, has shown potential as a nanomedicine for lung cancer treatment. RV has varied effects on cancer cells, including promoting apoptosis by increasing pro-apoptotic proteins (Bax and Bak) and decreasing anti-apoptotic proteins (Bcl-2). It also hinders cell proliferation by influencing important signaling pathways (MAPK, mTOR, PI3K/Akt, and Wnt/β-catenin) that govern cancer progression. In addition, RV acts as a potent antioxidant, diminishing oxidative stress and safeguarding cells against DNA damage. However, using RV alone in cancer treatment has drawbacks, such as low bioavailability, lack of targeting ability, and susceptibility to degradation. In contrast, nanoparticle-based delivery systems address these limitations and hold promise for improving treatment outcomes in lung cancer; nanoparticle formulations of RV offer advantages such as improved drug delivery, increased stability, controlled release, and targeted delivery to lung cancer cells. This article will provide an overview of lung cancer, explore the potential of RV as a therapeutic agent, discuss the benefits and challenges of nanoparticle-based drug delivery, and highlight the promise of RV nanoparticles for cancer treatment, including lung cancer. By optimizing these systems for clinical application, future studies aim to enhance overall treatment outcomes and improve the prognosis for lung cancer patients.
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Affiliation(s)
- Behnam Najafiyan
- Faculty of Pharmacy, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Samar Esmaelian
- Faculty of Dentistry, Islamic Azad University, Tehran Branch, Tehran, Iran
| | - Faezeh Firuzpour
- Student of Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | - Leila Kalantari
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Hheidari
- Department of Mechanical Engineering, Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Hassan Mesgari
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Islamic Azad University, Tehran Branch, Tehran, Iran.
| | - Mohsen Nabi-Afjadi
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.
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Elshami M, Sawafta N, Mansour A, Alser M, Al-Slaibi I, Abukmail H, Shurrab H, Qassem S, Usrof FD, Alruzayqat M, Aqel W, Nairoukh R, Kittaneh R, Habes YMN, Ghanim O, Aabed WA, Omar O, Daraghma M, Aljbour J, Elian REM, Zuhour A, Habes H, Al-Dadah M, Albarqi SI, Bottcher B, Abu-El-Noor N. Anticipated time to seek medical advice for possible lung cancer symptoms and barriers to timely presentation in Palestine: a national cross-sectional study. BMC Cancer 2024; 24:183. [PMID: 38326766 PMCID: PMC10848550 DOI: 10.1186/s12885-024-11935-1] [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: 09/03/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Lung cancer (LC) has poor survival outcomes mainly due to diagnosis at late stages. This study explored the anticipated time to seek medical advice for possible LC symptoms and barriers to early presentation in Palestine. METHODS This cross-sectional study recruited adult participants from hospitals, primary healthcare centers, and public spaces of 11 governorates using convenience sampling. A modified, translated-into-Arabic version of the validated LC awareness measure was used to assess LC symptom awareness, the time needed to seek medical advice and barriers to early presentation. RESULTS A total of 4762 participants were included. The proportion that would immediately seek medical advice for possible LC symptoms varied according to the symptoms' nature. For respiratory symptoms, this ranged from 15.0% for 'painful cough' to 37.0% for 'coughing up blood'. For non-respiratory symptoms, this ranged from '4.2% for 'unexplained loss of appetite' to 13.8% for 'changes in the shape of fingers or nails'. Participants with good LC symptom awareness were more likely to seek medical advice within a week of recognizing most LC symptoms. About 13.0% would delay their visit to see a doctor after recognizing an LC symptom. The most reported barriers were emotional with 'disliking the visit to healthcare facilities' (59.8%) as the leading barrier. CONCLUSION LC respiratory symptoms were more likely to prompt early seeking of medical advice. Good LC symptom awareness was associated with a higher likelihood of help-seeking within a week. Educational interventions are needed to promote LC awareness and address the perceived barriers to early presentation in low-resource settings, such as Palestine.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | - Nawras Sawafta
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Ahmad Mansour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Ramallah, West Bank, Palestine
| | - Mohammed Alser
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
- The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Gaza, Palestine
| | | | - Hanan Abukmail
- International Medical Corps, Gaza, Palestine
- Harvard Medical School, Boston, MA, USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hanan Shurrab
- Faculty of Pharmacy, Al-Azhar University of Gaza, Gaza, Palestine
| | - Shahd Qassem
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Faten Darwish Usrof
- Department of a Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza City, Palestine
| | | | - Wafa Aqel
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Roba Nairoukh
- Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine
| | - Rahaf Kittaneh
- Faculty of Nursing, An Najah National University, Nablus, Palestine
| | | | - Obaida Ghanim
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ola Omar
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Motaz Daraghma
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Jumana Aljbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Razan E M Elian
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Areen Zuhour
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Haneen Habes
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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9
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Elshami M, Qawasmi MA, Ghithan RJ, Al-Slaibi I, Alser M, Shurrab NR, Ismail IO, Mahfouz II, AbdulQader Fannon A, Hawa MR, Giacaman N, Ahmaro M, Okshiya HM, Zaatreh RK, AbuKhalil WA, Usrof FD, Melhim NK, Madbouh RJ, Abu Hziema HJ, Abed-Allateef Lahlooh R, Ubaiat SN, Jaffal NA, Alawna RK, Abed SN, Abuzahra BN, Abu Kwaik AJ, Dodin MH, Taha RO, Alashqar DM, Mobarak RAA, Smerat T, Albarqi SI, Abu-El-Noor N, Bottcher B. Barriers to Timely Seeking of Breast Cancer Care Among Palestinian Women: A Cross-Sectional Study. JCO Glob Oncol 2024; 10:e2300373. [PMID: 38386955 PMCID: PMC10898679 DOI: 10.1200/go.23.00373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Examining the association of breast cancer (BC) symptom awareness with time to help seeking and exploring barriers to timely presentation may enhance the effectiveness of BC awareness campaigns and early detection efforts. This study aimed to assess the anticipated time for seeking medical advice when experiencing a potential BC symptom among women in Palestine and to identify their barriers to early presentation. MATERIALS AND METHODS A convenience sampling method was used to recruit adult women from hospitals, primary health care facilities, and public areas across 11 governorates in Palestine. A translated-into-Arabic version of the validated BC Awareness Measure was used. The questionnaire consisted of three sections: sociodemographic information, recognition of 13 BC symptoms and reporting time for seeking medical advice, and barriers to early presentation. RESULTS A total of 5,257 questionnaires were included. The proportion of participants who would seek medical advice immediately varied on the basis of the nature of BC symptoms. For symptoms related to the breast, the proportion ranged from 25.7% for redness of the breast skin to 53.5% for a lump or thickening in the breast. For symptoms related to the nipple, the proportion ranged from 30.7% for nipple rash to 48.0% for discharge or bleeding from the nipple. Exhibiting good BC symptom awareness was associated with a higher likelihood of seeking medical advice within a week for all BC symptoms. Emotional barriers were the most frequently reported barriers. There was no association between increasing levels of BC awareness and reporting fewer or more barriers. CONCLUSION The nature of BC symptoms had an impact on help-seeking behaviors. Participants with good BC symptom awareness were more likely to seek medical advice earlier.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
- Ministry of Health, Gaza, Palestine
| | - Malak Ayman Qawasmi
- Department of Medical Laboratory Sciences, Hebron University, Hebron, Palestine
| | | | | | - Mohammed Alser
- The United Nations Relief and Works Agency for Palestine Refugees in the Near East, Gaza, Palestine
| | | | | | | | | | | | | | - Manar Ahmaro
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | - Faten Darwish Usrof
- Faculty of Health Sciences Master of Medical Laboratory Sciences, Islamic University of Gaza, Gaza, Palestine
| | | | | | | | | | | | - Nour Ali Jaffal
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | | | | | | | | | - Tasneem Smerat
- Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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10
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Muley T, Schneider MA, Meister M, Thomas M, Heußel CP, Kriegsmann M, Holdenrieder S, Wehnl B, Rolny V, Mang A, Gerber R, Herth F. CYFRA 21-1, CA 125 and CEA provide additional prognostic value in NSCLC patients with stable disease at first CT scan. Tumour Biol 2024; 46:S163-S175. [PMID: 37840516 DOI: 10.3233/tub-220042] [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] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Serum tumor markers (STM) may complement imaging and provide additional clinical information for patients with non-small cell lung cancer (NSCLC). OBJECTIVE To determine whether STMs can predict outcomes in patients with stable disease (SD) after initial treatment. METHODS This single-center, prospective, observational trial enrolled 395 patients with stage III/IV treatment-naïve NSCLC; of which 263 patients were included in this analysis. Computed Tomography (CT) scans were performed and STMs measured before and after initial treatment (two cycles of chemotherapy and/or an immune checkpoint inhibitor or tyrosine kinase inhibitor); analyses were based on CT and STM measurements obtained at first CT performed after cycle 2 only PFS and OS were analyzed by Kaplan-Meier curves and Cox-proportional hazard models. RESULTS When patients with SD (n = 100) were split into high- and low-risk groups based on CYFRA 21-1, CEA and CA 125 measurements using an optimized cut-off, a 4-fold increase risk of progression or death was estimated for high- vs low-risk SD patients (PFS, HR 4.17; OS, 3.99; both p < 0.0001). Outcomes were similar between patients with high-risk SD or progressive disease (n = 35) (OS, HR 1.17) and between patients with low-risk SD or partial response (n = 128) (PFS, HR 0.98; OS, 1.14). CONCLUSIONS STMs can provide further guidance in patients with indeterminate CT responses by separating them into high- and low-risk groups for future PFS and OS events.
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Affiliation(s)
- Thomas Muley
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mark A Schneider
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Meister
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Oncology, Thoraxklinik, University Hospital, Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, Institute of Pathology, University Hospital, Heidelberg, Germany
| | - Stefan Holdenrieder
- Department of Laboratory Medicine, Deutsches Herzzentrum München, Munich, Germany
| | | | | | - Anika Mang
- Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Felix Herth
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pulmonology and Critical Care, Thoraxklinik, University Hospital, Heidelberg, Germany
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11
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Crintea A, Constantin AM, Motofelea AC, Crivii CB, Velescu MA, Coșeriu RL, Ilyés T, Crăciun AM, Silaghi CN. Targeted EGFR Nanotherapy in Non-Small Cell Lung Cancer. J Funct Biomater 2023; 14:466. [PMID: 37754880 PMCID: PMC10532491 DOI: 10.3390/jfb14090466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide. Despite advances in treatment, the prognosis remains poor, highlighting the need for novel therapeutic strategies. The present review explores the potential of targeted epidermal growth factor receptor (EGFR) nanotherapy as an alternative treatment for NSCLC, showing that EGFR-targeted nanoparticles are efficiently taken up by NSCLC cells, leading to a significant reduction in tumor growth in mouse models. Consequently, we suggest that targeted EGFR nanotherapy could be an innovative treatment strategy for NSCLC; however, further studies are needed to optimize the nanoparticles and evaluate their safety and efficacy in clinical settings and human trials.
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Affiliation(s)
- Andreea Crintea
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.C.); (T.I.); (C.N.S.)
| | - Anne-Marie Constantin
- Department of Morphological Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.-M.C.); (C.-B.C.)
| | - Alexandru C. Motofelea
- Department of Internal Medicine, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania;
| | - Carmen-Bianca Crivii
- Department of Morphological Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.-M.C.); (C.-B.C.)
| | - Maria A. Velescu
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania;
| | - Răzvan L. Coșeriu
- Department of Microbiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Târgu-Mureș, Romania;
| | - Tamás Ilyés
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.C.); (T.I.); (C.N.S.)
| | - Alexandra M. Crăciun
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.C.); (T.I.); (C.N.S.)
| | - Ciprian N. Silaghi
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400349 Cluj-Napoca, Romania; (A.C.); (T.I.); (C.N.S.)
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12
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Bermúdez G, Bernal C, Otalora A, Sanchez P, Nardocci G, Cañas A, Lopez-Kleine L, Montecino M, Rojas A. Long Noncoding RNA TALAM1 Is a Transcriptional Target of the RUNX2 Transcription Factor in Lung Adenocarcinoma. Curr Issues Mol Biol 2023; 45:7075-7086. [PMID: 37754231 PMCID: PMC10529414 DOI: 10.3390/cimb45090447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death worldwide. It has been reported that genetic and epigenetic factors play a crucial role in the onset and evolution of lung cancer. Previous reports have shown that essential transcription factors in embryonic development contribute to this pathology. Runt-related transcription factor (RUNX) proteins belong to a family of master regulators of embryonic developmental programs. Specifically, RUNX2 is the master transcription factor (TF) of osteoblastic differentiation, and it can be involved in pathological conditions such as prostate, thyroid, and lung cancer by regulating apoptosis and mesenchymal-epithelial transition processes. In this paper, we identified TALAM1 (Metastasis Associated Lung Adenocarcinoma Transcript 1) as a genetic target of the RUNX2 TF in lung cancer and then performed functional validation of the main findings. METHODS We performed ChIP-seq analysis of tumor samples from a patient diagnosed with lung adenocarcinoma to evaluate the target genes of the RUNX2 TF. In addition, we performed shRNA-mediated knockdown of RUNX2 in this lung adenocarcinoma cell line to confirm the regulatory role of RUNX2 in TALAM1 expression. RESULTS We observed RUNX2 overexpression in cell lines and primary cultured lung cancer cells. Interestingly, we found that lncRNA TALAM1 was a target of RUNX2 and that RUNX2 exerted a negative regulatory effect on TALAM1 transcription.
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Affiliation(s)
- Gisella Bermúdez
- Institute of Human Genetics, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá, Bogotá 110231, Colombia; (G.B.); (C.B.); (A.O.); (P.S.)
| | - Camila Bernal
- Institute of Human Genetics, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá, Bogotá 110231, Colombia; (G.B.); (C.B.); (A.O.); (P.S.)
| | - Andrea Otalora
- Institute of Human Genetics, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá, Bogotá 110231, Colombia; (G.B.); (C.B.); (A.O.); (P.S.)
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá 110211, Colombia
| | - Paula Sanchez
- Institute of Human Genetics, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá, Bogotá 110231, Colombia; (G.B.); (C.B.); (A.O.); (P.S.)
| | - Gino Nardocci
- School of Medicine, Faculty of Medicine, Universidad de los Andes, Santiago 7620001, Chile;
- Molecular Biology and Bioinformatics Lab., Program in Molecular Biology and Bioinformatics, Center for Biomedical Research and Innovation (CIIB), Universidad de los Andes, Santiago 7620001, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 7620001, Chile
| | - Alejandra Cañas
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | - Liliana Lopez-Kleine
- Departamento de Estadística, Universidad Nacional de Colombia, Bogotá 111321, Colombia;
| | - Martín Montecino
- Institute of Biomedical Sciences, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago 8370134, Chile;
| | - Adriana Rojas
- Institute of Human Genetics, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá, Bogotá 110231, Colombia; (G.B.); (C.B.); (A.O.); (P.S.)
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13
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Butler SJ, Louie AV, Sutradhar R, Paszat L, Brooks D, Gershon AS. Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study. Curr Oncol 2023; 30:6397-6410. [PMID: 37504331 PMCID: PMC10377848 DOI: 10.3390/curroncol30070471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.
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Affiliation(s)
- Stacey J Butler
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lawrence Paszat
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Andrea S Gershon
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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14
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Mudaranthakam DP, Nollen N, Wick J, Hughes D, Welch D, Calhoun E. Evaluating Work Impairment as a Source of Financial Toxicity in Cancer Healthcare and Negative Impacts on Health Status. CANCER RESEARCH COMMUNICATIONS 2023; 3:1166-1172. [PMID: 37415746 PMCID: PMC10321355 DOI: 10.1158/2767-9764.crc-23-0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/17/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
How the socioeconomic factors intersect for a particular patient can determine their susceptibility to financial toxicity, what costs they will encounter during treatment, the type and quality of their care, and the potential work impairments they face. The primary goal of this study was to evaluate financial factors leading to worsening health outcomes by the cancer subtype. A logistic model predicting worsening health outcomes while assessing the most influential economic factors was constructed by the University of Michigan Health and Retirement Study. A forward stepwise regression procedure was implemented to identify the social risk factors that impact health status. Stepwise regression was done on data subsets based on the cancer types of lung, breast, prostate, and colon cancer to determine whether significant predictors of worsening health status were different or the same across cancer types. Independent covariate analysis was also conducted to cross-validate our model. On the basis of the model fit statistics, the two-factor model has the best fit, that is, the lowest AIC among potential models of 3270.56, percent concordance of 64.7, and a C-statistics of 0.65. The two-factor model used work impairment and out-of-pocket costs, significantly contributing to worsening health outcomes. Covariate analysis demonstrated that younger patients with cancer experienced more financial burdens leading to worsening health outcomes than elderly patients aged 65 years and above. Work impairment and high out-of-pocket costs were significantly associated with worsening health outcomes among cancer patients. Matching the participants who need the most financial help with appropriate resources is essential to mitigate the financial burden. Significance Among patients with cancer, work impairment and out-of-pocket are the two primary factors contributing to adverse health outcomes. Women, African American or other races, the Hispanic population, and younger individuals have encountered higher work impairment and out-of-pocket costs due to cancer than their counterparts.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Comprehensive Cancer Center, Kansas City, Kansas
| | - Nicole Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Comprehensive Cancer Center, Kansas City, Kansas
| | - Jo Wick
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Comprehensive Cancer Center, Kansas City, Kansas
| | - Dorothy Hughes
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Danny Welch
- University of Kansas Comprehensive Cancer Center, Kansas City, Kansas
| | - Elizabeth Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- Population Health Sciences, University of Illinois Chicago, Chicago, Illinois
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Dera AA, Zaib S, Hussain N, Rana N, Javed H, Khan I. Identification of Potent Inhibitors Targeting EGFR and HER3 for Effective Treatment of Chemoresistance in Non-Small Cell Lung Cancer. Molecules 2023; 28:4850. [PMID: 37375404 DOI: 10.3390/molecules28124850] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. Despite the existence of various therapeutic options, NSCLC is still a major health concern due to its aggressive nature and high mutation rate. Consequently, HER3 has been selected as a target protein along with EGFR because of its limited tyrosine kinase activity and ability to activate PI3/AKT pathway responsible for therapy failure. We herein used a BioSolveIT suite to identify potent inhibitors of EGFR and HER3. The schematic process involves screening of databases for constructing compound library comprising of 903 synthetic compounds (602 for EGFR and 301 for HER3) followed by pharmacophore modeling. The best docked poses of compounds with the druggable binding site of respective proteins were selected according to pharmacophore designed by SeeSAR version 12.1.0. Subsequently, preclinical analysis was performed via an online server SwissADME and potent inhibitors were selected. Compound 4k and 4m were the most potent inhibitors of EGFR while 7x effectively inhibited the binding site of HER3. The binding energies of 4k, 4m, and 7x were -7.7, -6.3 and -5.7 kcal/mol, respectively. Collectively, 4k, 4m and 7x showed favorable interactions with the most druggable binding sites of their respective proteins. Finally, in silico pre-clinical testing by SwissADME validated the non-toxic nature of compounds 4k, 4m and 7x providing a promising treatment option for chemoresistant NSCLC.
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Affiliation(s)
- Ayed A Dera
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Sumera Zaib
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Nehal Rana
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Hira Javed
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Imtiaz Khan
- Department of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester M1 7DN, UK
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16
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Davies L, Milner DA, Shulman LN, Kyokunda L, Bedada A, Vuylsteke P, Masalu N, Jackson P, Jennings N, Odunlami A, Mtshali P, Dugan U. Analysis of Cancer Research Projects in Sub-Saharan Africa: A Quantitative Perspective on Unmet Needs and Opportunities. JCO Glob Oncol 2023; 9:e2200203. [PMID: 37290022 PMCID: PMC10497259 DOI: 10.1200/go.22.00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/27/2023] [Accepted: 03/16/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE To evaluate the scope and types of cancer research projects in sub-Saharan Africa (SSA) to identify research gaps and inform future efforts. METHODS This retrospective observational study summarized information on cancer research projects in SSA from the International Cancer Research Partnership (ICRP) between 2015 and 2020, alongside 2020 cancer incidence and mortality data from the Global Cancer Observatory. SSA cancer research projects were identified as led by investigators in SSA countries, or by investigators in non-SSA countries with collaborators in SSA, or in database keyword searches. Projects from the Coalition for Implementation Research in Global Oncology (CIRGO) were also summarized. RESULTS A total of 1,846 projects were identified from the ICRP database, funded by 34 organizations in seven countries (only one, Cancer Association of South Africa, based in SSA); only 156 (8%) were led by SSA-based investigators. Most projects focused on virally induced cancers (57%). Across all cancer types, projects were most frequently related to cervical cancer (24%), Kaposi sarcoma (15%), breast cancer (10%), or non-Hodgkin lymphoma (10%). Gaps were observed for several cancers with higher incidence/mortality burden in SSA; for example, prostate cancer accounted for only 4% of projects but 8% of cancer-related deaths and 10% of new cases. Approximately 26% were dedicated to etiology. Treatment-related research declined over the study period (14%-7% of all projects), while projects related to prevention (15%-20%) and diagnosis/prognosis (15%-29%) increased. Fifteen CIRGO projects were identified; seven were relevant across multiple cancer types, and 12 focused either wholly or partially on cancer control (representing 50% of the total research effort). CONCLUSION This analysis shows notable discrepancies between cancer burden and research projects and identifies opportunities for future strategic investments in cancer care in SSA.
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Affiliation(s)
- Lynne Davies
- International Cancer Research Partnership, Cardiff, United Kingdom
| | | | | | - Lynnette Kyokunda
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Alemayehu Bedada
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Peter Vuylsteke
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Nestory Masalu
- Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Tanzania
| | - Paul Jackson
- Cancer Australia, Strawberry Hills, NSW, Australia
| | | | | | | | - Ute Dugan
- Parker Institute for Cancer Immunotherapy, San Francisco, CA
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17
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Black GB, Boswell L, Harris J, Whitaker KL. What causes delays in diagnosing blood cancers? A rapid review of the evidence. Prim Health Care Res Dev 2023; 24:e26. [PMID: 37039465 PMCID: PMC10156470 DOI: 10.1017/s1463423623000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours. METHODS We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English. RESULTS Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway. CONCLUSION Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
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Affiliation(s)
- Georgia B. Black
- Reader in Applied Health Research, Wolfson Institute of Population Health,
Queen Mary University of London, London,
UK
| | - Laura Boswell
- PhD student, School of Health Sciences, University of
Surrey, Guildford, UK
| | - Jenny Harris
- Senior Lecturer in Cancer Care, School of Health Sciences,
University of Surrey, Guildford,
UK
| | - Katriina L. Whitaker
- Professor of Psychology and Lead for Cancer Care, School of Health
Sciences, University of Surrey, Guildford,
UK
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18
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Gurney J, Davies A, Stanley J, Signal V, Costello S, Dawkins P, Henare K, Jackson C, Lawrenson R, Whitehead J, Koea J. Emergency presentation prior to lung cancer diagnosis: A national-level examination of disparities and survival outcomes. Lung Cancer 2023; 179:107174. [PMID: 36958240 DOI: 10.1016/j.lungcan.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES A recent multinational investigation of emergency presentation within 30 days of cancer diagnosis, conducted within the International Cancer Benchmarking Programme (ICBP), observed that New Zealand had the highest rate of emergency presentation prior to lung cancer diagnosis compared to other similar countries. Here we use national-level health data to further investigate these trends, focussing on ethnic disparities in emergency presentation prior to lung cancer diagnosis. We have also compared survival outcomes between those who had an emergency presentation in the preceding 30 days to those who did not. MATERIALS AND METHODS Our study included all lung cancer registrations between 2007 and 2019 on the New Zealand Cancer Registry (N = 27,869), linked to national hospitalisation and primary healthcare data. We used descriptive (crude and age-standardised proportions) and logistic regression (crude and adjusted odds ratios) analyses to examine primary care access prior to cancer diagnosis, emergency hospitalisation up to and including 30 days prior to diagnosis, and one-year mortality post-diagnosis, both for the total population and between ethnicities. Regression models adjusted for age, sex, deprivation, rurality, comorbidity, tumour type and stage. RESULTS We found stark disparities by ethnic group, with 62% of Pacific peoples and 54% of Māori having an emergency presentation within 30 days prior to diagnosis, compared to 47% of Europeans. These disparities remained after adjusting for multiple covariates including comorbidity and deprivation (adj. OR: Māori 1.21, 95% CI 1.13-1.30; Pacific 1.50, 95% CI 1.31-1.71). Emergency presentation was associated with substantially poorer survival outcomes across ethnic groups (e.g. 1-year mortality for Māori: no emergency presentation 50%, emergency presentation 79%; adj. OR 2.40, 95% CI 2.10-2.74). CONCLUSIONS These observations reinforce the need for improvements in the early detection of lung cancer, particularly for Māori and Pacific populations, with a view to preventing diagnosis of these cancers in an emergency setting.
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Affiliation(s)
- Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Anna Davies
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shaun Costello
- Southern Blood and Cancer Unit, Te Whatu Ora - Southern, Dunedin, New Zealand
| | - Paul Dawkins
- Respiratory Services, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | - Kimiora Henare
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Chris Jackson
- Southern Blood and Cancer Unit, Te Whatu Ora - Southern, Dunedin, New Zealand; Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand; Population and Public Health, Te Whatu Ora - Waikato, Hamilton, New Zealand
| | - Jesse Whitehead
- Te Ngira Institute for Population Research, University of Waikato, New Zealand
| | - Jonathan Koea
- General Surgery Services, Te Whatu Ora, Waitematā, Auckland, New Zealand
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19
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Punnett G, Fenemore J, Blackhall F, Yorke J. Support and information needs for patients with non-small cell lung cancer receiving concurrent chemo-radiotherapy treatment with curative intent: Findings from a qualitative study. Eur J Oncol Nurs 2023; 64:102325. [PMID: 37146348 DOI: 10.1016/j.ejon.2023.102325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Concurrent chemotherapy and radiotherapy treatment (CCRT) is used to treat locally advanced Non-Small Cell Lung Cancer (NSCLC) in patients with suitable fitness. CCRT is associated with significant toxicity and time spent receiving treatment. Our aim was to identify the support and information needs of patients, and where possible their informal caregivers (IC), at key points along the CCRT pathway. METHODS Participants were NSCLC patients who were either about to undergo, currently receiving or had finished CCRT. Semi-structured interviews were conducted with participants, and their IC where applicable, at the treatment centre or participants' home. Interviews were audio recorded and transcribed prior to undergoing thematic analysis. RESULTS Fifteen patients were interviewed; five were interviewed with their IC. Themes of physical, psychological, and practical support needs are identified with associated subthemes exploring specific needs, such as dealing with late treatment effects, and how patients seek support. Information needs prior to, during and following CCRT were also established as predominant themes with subthemes detailing the needs at these time points. Examples include differences in participant desire for toxicity information and life after treatment. CONCLUSIONS The need for disease, treatment and symptom related information and support remains consistent throughout CCRT and beyond. Further information and support for other matters including engaging in regular activities may also be desired. Time allocated within consultations to establish changes in needs or desire for further information may benefit patient and IC experience and QOL.
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20
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Elshami M, Mansour A, Alser M, Al-Slaibi I, Abukmail H, Shurrab H, Qassem S, Usrof FD, Alruzayqat M, Aqel W, Nairoukh R, Kittaneh R, Sawafta N, Habes YMN, Ghanim O, Aabed WA, Omar O, Daraghmeh M, Aljbour J, Elian REM, Zhor A, Habes H, Al-Dadah M, Abu-El-Noor N, Bottcher B. Current situation and future directions of lung cancer risk factor awareness in Palestine: a cross-sectional study. BMJ Open 2023; 13:e061110. [PMID: 36653053 PMCID: PMC9853137 DOI: 10.1136/bmjopen-2022-061110] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To evaluate lung cancer (LC) risk factor awareness among Palestinians and identify factors associated with good awareness. DESIGN Cross-sectional study. SETTINGS Participants were recruited using convenience sampling from hospitals, primary healthcare centres (PHCs) and public spaces located at 11 governorates in Palestine. PARTICIPANTS Of 5174 approached, 4817 participants completed the questionnaire (response rate=93.1%). A total of 4762 questionnaires were included: 2742 from the West Bank and Jerusalem (WBJ) and 2020 from the Gaza Strip. Exclusion criteria were working or studying in a health-related field, having a nationality other than Palestinian and visiting oncology departments or clinics at the time of data collection. TOOL: A modified version of the validated LC Awareness Measure was used for data collection. PRIMARY AND SECONDARY OUTCOMES The primary outcome was LC risk factor awareness level as determined by the number of factors recognised: poor (0-3), fair (4-7) and good (8-10). Secondary outcomes include the recognition of each LC risk factor. RESULTS Smoking-related risk factors were more often recognised than other LC risk factors. The most recognised risk factors were 'smoking cigarettes' (n=4466, 93.8%) and 'smoking shisha (waterpipes)' (n=4337, 91.1%). The least recognised risk factors were 'having a close relative with LC' (n=2084, 43.8%) and 'having had treatment for any cancer in the past' (n=2368, 49.7%).A total of 2381 participants (50.0%) displayed good awareness of LC risk factors. Participants from the WBJ and the Gaza Strip had similar likelihood to display good awareness (50.6% vs 49.1%). Being≥45 years, having higher education and monthly income, knowing someone with cancer and visiting hospitals and PHCs seemed to have a positive impact on displaying good awareness. CONCLUSION Half of study participants displayed good awareness of LC risk factors. Educational interventions are warranted to further improve public awareness of LC risk factors, especially those unrelated to smoking.
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Affiliation(s)
- Mohamedraed Elshami
- Ministry of Health, Gaza, Palestine
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad Mansour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Palestine Medical Complex, Ramallah, Palestine
| | - Mohammed Alser
- Islamic University of Gaza, Gaza, Palestine
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, Gaza, Palestine
| | | | - Hanan Abukmail
- International Medical Corps, Gaza, Palestine
- Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Hanan Shurrab
- Faculty of Pharmacy, Al-Azhar University of Gaza, Gaza, Palestine
| | - Shahd Qassem
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Faten Darwish Usrof
- Department of a Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza, Palestine
| | | | - Wafa Aqel
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Roba Nairoukh
- Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine
| | - Rahaf Kittaneh
- Faculty of Nursing, An-Najah National University, Nablus, Palestine
| | - Nawras Sawafta
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Obaida Ghanim
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ola Omar
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Motaz Daraghmeh
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Jomana Aljbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Areen Zhor
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Haneen Habes
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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21
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Al-Hosni K, Chan MF, Al-Azri M. Effectiveness of an Educational Program on Awareness of Cancer Risk Factors, Symptoms, and Barriers to Medical Help-Seeking Among Adolescent Omani Students: an Interventional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-023-02263-2. [PMID: 36609965 DOI: 10.1007/s13187-023-02263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
Cancer is the second leading cause of death worldwide, with attributable mortality expected to continue increasing over time. High school students are often targeted to enhance awareness of cancer risk factors and symptoms and promote early medical help-seeking behaviors. This study aimed to evaluate the effectiveness of a cancer education program among Omani adolescents. A total of 12 public schools were randomly selected from three governorates and assigned to either the intervention or control group. Students attending grades 10 and 11 at the selected schools were targeted. The Cancer Awareness Measure tool was used to evaluate knowledge of cancer risk factors and symptoms, perceived barriers to seeking medical help, and anticipated time to consult a doctor for cancer warning symptoms at baseline (T0) and after 4 weeks (T1). After T0, the intervention group participated in a 1-h cancer education program involving a slideshow presentation and group discussion; they also received a leaflet and online access to program materials and videos. A total of 1716 students were enrolled in the study, including 886 (51.6%) assigned to the control group and 830 (48.4%) to the intervention group. Recognition of cancer risk factors (Z = 24.86; p ˂ 0.001) and cancer symptoms (Z = 24.91; p ˂ 0.001) significantly improved in the intervention group between T0 and T1, and compared to the control group at T1 (U = 33.28; p ˂ 0.001, and U = 34.55; p ˂ 0.001, respectively). In addition, anticipated time to help-seeking (Z = 20.15; p ˂ 0.001) and barriers to help-seeking (Z = 10.33; p < 0.001) decreased significantly between T0 and T1, and compared to the control group at T1 (U = 19.00; p ˂ 0.001, and U = 3.58; p < 0.001, respectively). The intervention effectively increased knowledge of cancer risk factors and symptoms and promoted early medical help-seeking behaviors among school-aged Omani adolescents. Integration of cancer education within high school curricula can aid cancer prevention and early intervention efforts. However, additional follow-up is required to confirm the long-term effectiveness of such programs.
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Affiliation(s)
- Khadija Al-Hosni
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
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22
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Schwalk A, Styrvoky K. Longitudinal use of three different navigational bronchoscopy systems to sample lung nodules in a single patient. Respir Med Case Rep 2023; 43:101855. [PMID: 37138799 PMCID: PMC10149411 DOI: 10.1016/j.rmcr.2023.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
Bronchoscopic techniques to sample suspicious lung nodules have progressed from traditional bronchoscopy to guided navigational bronchoscopy systems. Here we present the case of a patient who underwent navigational bronchoscopies using three different systems over a period of 41 months that diagnosed two primary and one metastatic thoracic malignancy. As guided bronchoscopy systems for the diagnosis of lung nodules continue to advance, it is important to recognize that the full utilization of accessible tools and technologies combined with shared decision making may often lead to a successful procedure and accurate diagnosis.
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Affiliation(s)
| | - Kim Styrvoky
- Corresponding author. University of Texas Southwestern Medical Center, Division of Pulmonary and Critical Care Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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23
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Li Q, Tang Y, Wang T, Zhu J, Zhou Y, Shi J. Novel immunogenic cell death-related risk signature to predict prognosis and immune microenvironment in lung adenocarcinoma. J Cancer Res Clin Oncol 2023; 149:307-323. [PMID: 36575346 DOI: 10.1007/s00432-022-04555-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Immunogenic cell death (ICD) is a type of regulated cell death (RCD) which was discovered to activate adaptive immunity. To date, the effect of ICD on lung adenocarcinoma (LUAD) remains unclear. In this research, we will study the role of ICD-related genes (ICDG) in LUAD. METHODS RNA sequencing and clinical data were gathered from TCGA-LUAD cohorts and GEO database. Using unsupervised cluster analysis, three clusters were identified with distinctive immune characteristics and significant overall survival based on 18 ICDG. Using LASSO Cox regression, three genes were identified and used to construct the prognosis signature. The association between the 3-ICDG risk signature and immune microenvironment analysis, somatic mutation, and enriched molecular pathways was investigated. RESULTS Consensus clustering separated the LUAD samples into three clusters (ICDcluster A, B and C), and ICDcluster B had the best prognosis. Different TME cell infiltration characteristics and biological behavior were found in three ICD clusters. Prognostic risk model was contrasted based on the 3 best prognostic ICD-related genes. Subsequently, vitro experiments verified the above analysis results. The high-risk group showed a poor prognosis and enrichment of cancer promoting signal pathway. Multivariate analysis indicated that this 3-ICDG prognostic model might be an accurate prediction parameter for LUAD. Moreover, conducting immune related analysis, we found that the 3-ICDG risk signature was characterized by an immune-active subtype on account of the high infiltration of immune-active cells. CONCLUSION This study expands our cognition of ICD in LUAD microenvironment, excavated prognostic biomarkers, and provided potential value for guiding immunotherapy and chemotherapy.
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Affiliation(s)
- Qixuan Li
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Yijie Tang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Tianyi Wang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Jiaqi Zhu
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.,Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Youlang Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Jiahai Shi
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China. .,Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China. .,School of Public Health, Nantong University, Nantong, 226001, Jiangsu, China.
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24
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Herb J, Friedman H, Shrestha S, Kent EE, Stitzenberg K, Haithcock B, Mody GN. Barriers and facilitators to early-stage lung cancer care in the USA: a qualitative study. Support Care Cancer 2022; 31:21. [PMID: 36513843 PMCID: PMC9747538 DOI: 10.1007/s00520-022-07465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Improved outcomes in lung cancer treatment are seen in high-volume academic centers, making it important to understand barriers to accessing care at such institutions. Few qualitative studies examine the barriers and facilitators to early-stage lung cancer care at US academic institutions. METHODS Adult patients with suspected or diagnosed early-stage non-small cell lung cancer presenting to a multidisciplinary lung cancer clinic at a US academic institution over a 6-month period beginning in 2019 were purposively sampled for semi-structured interviews. Semi-structured interviews were conducted and a qualitative content analysis was performed using the framework method. Themes relating to barriers and facilitators to lung cancer care were identified through iterative team-based coding. RESULTS The 26 participants had a mean age of 62 years (SD: 8.4 years) and were majority female (62%), white (77%), and urban (85%). We identified 6 major themes: trust with providers and health systems are valued by patients; financial toxicity negatively influenced the diagnostic and treatment experience; social constraints magnified other barriers; patient self-advocacy as a facilitator of care access; provider advocacy could overcome other barriers; care coordination and good communication were important to patients. CONCLUSIONS We have identified several barriers and facilitators to lung cancer care at an academic center in the US. These factors need to be addressed to improve quality of care among lung cancer patients. Further work will examine our findings in a community setting to understand if our findings are generalizable to patients who do not access a tertiary cancer care center.
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Affiliation(s)
- Joshua Herb
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Hannah Friedman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sachita Shrestha
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Kent
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn Stitzenberg
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gita N Mody
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Vognsgaard F, Sætre LMS, Rasmussen S, Jarbøl DE. Associations between smoking status and involvement of personal and professional relations among individuals reporting symptoms related to a diagnosis of lung cancer: a population-based study. BMC Public Health 2022; 22:2284. [PMID: 36474198 PMCID: PMC9724281 DOI: 10.1186/s12889-022-14719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoking is the leading cause of lung cancer, but individuals who currently smoke seek healthcare less frequently. This study of individuals reporting symptoms related to diagnosis of lung cancer has the following aims: 1) to explore the involvement of personal and professional relations; 2) to analyse whether age, sex and smoking status are associated with involving personal and professional relations; and 3) to analyse whether involving a personal relation is associated with healthcare-seeking. METHODS Data was extracted from a Danish population-based survey from 2012 with 100,000 randomly selected invitees 20 years or older. We describe the involvement of personal and professional relations among individuals experiencing four predefined symptoms indicative of lung cancer: prolonged coughing, prolonged hoarseness, shortness of breath and haemoptysis, either alone or in combination. Using multivariate logistic regression, we analyse the associations between involving personal or professional relations and various covariates (sex, age, smoking status). Moreover, we analyse the association between involving a personal relation and healthcare-seeking. RESULTS A total of 35,958 individuals over 40 years old completed the questionnaire. Of these, 5,869 individuals reported at least one lung cancer symptom. A higher percentage of participants with prolonged hoarseness and prolonged coughing reported no involvement of personal and professional relations (27.6% and 22.7%, respectively) compared to shortness of breath (12.4%). The most involved personal and professional relations were the spouse (46.2-62.5%) and the general practitioner (GP) (31.3-54.5%), respectively. Women and individuals in the oldest age group had higher odds of involving personal and professional relations. Individuals who currently smoke involved all relations less frequently than individuals who formerly,- and never smoked. Odds of contacting the GP or another doctor were three to seven-fold higher when a personal relation was also involved. CONCLUSION Women and the oldest age group had higher odds of involving relations, whereas individuals who currently smoked tended to be less likely to contact any personal or professional relations. Involving a personal relation was associated with higher odds of healthcare-seeking. The findings could be useful for GPs in terms of identifying patients at risk of postponing relevant healthcare-seeking with potential lung cancer symptoms.
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Affiliation(s)
- Frederik Vognsgaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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26
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Sætre LMS, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. A population-based study on social inequality and barriers to healthcare-seeking with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:48. [PMID: 36335123 PMCID: PMC9637082 DOI: 10.1038/s41533-022-00314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.
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Affiliation(s)
- Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Saab MM, McCarthy M, O'Driscoll M, Sahm LJ, Leahy-Warren P, Noonan B, FitzGerald S, O'Malley M, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. A systematic review of interventions to recognise, refer and diagnose patients with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:42. [PMID: 36258020 PMCID: PMC9579201 DOI: 10.1038/s41533-022-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with lung cancer (LC) often experience delay between symptom onset and treatment. Primary healthcare professionals (HCPs) can help facilitate early diagnosis of LC through recognising early signs and symptoms and making appropriate referrals. This systematic review describes the effect of interventions aimed at helping HCPs recognise and refer individuals with symptoms suggestive of LC. Seven studies were synthesised narratively. Outcomes were categorised into: Diagnostic intervals; referral and diagnosis patterns; stage distribution at diagnosis; and time interval from diagnosis to treatment. Rapid access pathways and continuing medical education for general practitioners can help reduce LC diagnostic and treatment delay. Awareness campaigns and HCP education can help inform primary HCPs about referral pathways. However, campaigns did not significantly impact LC referral rates or reduce diagnostic intervals. Disease outcomes, such as LC stage at diagnosis, recurrence, and survival were seldom measured. Review findings highlight the need for longitudinal, powered, and controlled studies.
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Affiliation(s)
- Mohamad M Saab
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Megan McCarthy
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Michelle O'Driscoll
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brendan Noonan
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maria O'Malley
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Merritt JC, Richbart SD, Moles EG, Cox AJ, Brown KC, Miles SL, Finch PT, Hess JA, Tirona MT, Valentovic MA, Dasgupta P. Anti-cancer activity of sustained release capsaicin formulations. Pharmacol Ther 2022; 238:108177. [PMID: 35351463 PMCID: PMC9510151 DOI: 10.1016/j.pharmthera.2022.108177] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
Capsaicin (trans-8-methyl-N-vanillyl-6-noneamide) is a hydrophobic, lipophilic vanilloid phytochemical abundantly found in chili peppers and pepper extracts. Several convergent studies show that capsaicin displays robust cancer activity, suppressing the growth, angiogenesis and metastasis of several human cancers. Despite its potent cancer-suppressing activity, the clinical applications of capsaicin as a viable anti-cancer drug have remained problematic due to its poor bioavailability and aqueous solubility properties. In addition, the administration of capsaicin is associated with adverse side effects like gastrointestinal cramps, stomach pain, nausea and diarrhea and vomiting. All these hurdles may be circumvented by encapsulation of capsaicin in sustained release drug delivery systems. Most of the capsaicin-based the sustained release drugs have been tested for their pain-relieving activity. Only a few of these formulations have been investigated as anti-cancer agents. The present review describes the physicochemical properties, bioavailability, and anti-cancer activity of capsaicin-sustained release agents. The asset of such continuous release capsaicin formulations is that they display better solubility, stability, bioavailability, and growth-suppressive activity than the free drug. The encapsulation of capsaicin in sustained release carriers minimizes the adverse side effects of capsaicin. In summary, these capsaicin-based sustained release drug delivery systems have the potential to function as novel chemotherapies, unique diagnostic imaging probes and innovative chemosensitization agents in human cancers.
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Affiliation(s)
- Justin C Merritt
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Stephen D Richbart
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Emily G Moles
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Ashley J Cox
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Kathleen C Brown
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Sarah L Miles
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Paul T Finch
- Department of Oncology, Edwards Cancer Center, Joan C. Edwards School of Medicine, Marshall University, 1400 Hal Greer Boulevard, Huntington, WV 25755, United States
| | - Joshua A Hess
- Department of Oncology, Edwards Cancer Center, Joan C. Edwards School of Medicine, Marshall University, 1400 Hal Greer Boulevard, Huntington, WV 25755, United States
| | - Maria T Tirona
- Department of Hematology-Oncology, Edwards Cancer Center, Joan C. Edwards School of Medicine, Marshall University, 1400 Hal Greer Boulevard, Huntington, WV 25755, United States
| | - Monica A Valentovic
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States
| | - Piyali Dasgupta
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States.
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Niranjan N, Sriram KB. New lung cancer diagnosis after emergency department presentation in a tertiary hospital: patient characteristics and outcomes. Hosp Pract (1995) 2022; 50:356-360. [PMID: 36056584 DOI: 10.1080/21548331.2022.2121573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Currently there is limited data available about patients who are diagnosed with lung cancer following an emergency department (ED) visit. This study sought to define the demographics, symptoms profile, staging, and prognosis of this cohort of patients. METHODS We conducted a retrospective study of patients diagnosed with a primary lung malignancy at a lung cancer multi-disciplinary meeting between January 2018-January 2020. Medical records were reviewed to collect data around demographics, presenting symptoms, investigations, admission, cancer stage, and mortality. RESULTS During the study period, 890 patients were diagnosed with a primary lung malignancy of which 209 (23.5%) presented to ED prompting diagnostic work-up. Of these 209 patients, 89% were hospitalised for a median duration of 6 days. 104 (50%) were female and average age of cohort was 70 years. Dyspnoea (38%) was the most common presenting symptom. Radiological staging and tissue biopsy was performed as an outpatient procedure in 46% and 41% of patients respectively. 188 patients had non-small cell lung cancer of whom 68% had Stage IV disease. 53 (25%) patients died within 3 months of ED presentation. These patients were older with more advanced disease compared to patients who were alive at 3 months. CONCLUSION : Emergent diagnosed patients are a significant proportion of the lung cancer population, presenting with advanced stage disease and increased short-term mortality. Future research should be directed at interventions, such as lung cancer screening program and/or community education to reduce the need for patients to present the emergency department with disabling lung cancer symptoms.
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Affiliation(s)
- Navin Niranjan
- Department of Respiratory Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Krishna Bajee Sriram
- Department of Respiratory Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,School of Medicine and Dentistry, Parklands Drive, Griffith University, Southport, Queensland 4215, Australia
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Saab MM, Kilty C, Noonan B, FitzGerald S, Collins A, Lyng Á, Kennedy U, Hegarty J. Public Health Messaging and Strategies to Promote "SWIFT" Lung Cancer Detection: a Qualitative Study Among High-Risk Individuals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1026-1035. [PMID: 33131021 PMCID: PMC9399198 DOI: 10.1007/s13187-020-01916-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
Lung cancer (LC) is the most common cancer and the leading cause of cancer mortality globally. A positive association between LC incidence and socioeconomic deprivation exists. High-risk individuals are less likely to be aware of LC and to correctly appraise LC symptoms and seek medical help accordingly. This qualitative study explored strategies to promote early detection of LC among at-risk individuals living in high-incidence areas in Ireland. Five semi-structured focus groups were conducted with 46 individuals. Data were collected face-to-face in community centres and organisations in high-incidence areas in two Irish counties and analysed using inductive qualitative content analysis. Participants believed that there was insufficient information regarding LC and recommended promoting LC awareness at a young rather than old age. They favoured public health messages that are Simple, clear, and honest; Worded positively; Incorporating a shock element; Featuring a celebrity, healthcare professional, or survivor; and Targeted (SWIFT). Most participants reported becoming immune to messages on cigarette packaging and recommended using a combination of broadcast and print media within national government-run campaigns to promote LC awareness and early detection. Study findings suggest that promoting LC awareness, help-seeking, early presentation, and diagnosis can be achieved by developing and testing targeted interventions. Promoting LC awareness requires a multi-sectoral policy network, or a whole systems approach. Such approaches ought to consider the multifactorial drivers of LC risk behaviours; involve coordinated, collective actions across various stakeholders; operate across multiple agencies; and take a life course perspective.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, T12 AK54, Cork, Ireland.
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Abigail Collins
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, T12 AK54, Cork, Ireland
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Zhu J, Wang J, Wang T, Zhou H, Xu M, Zha J, Feng C, Shen Z, Jiang Y, Chen J. Identification of molecular subtypes, risk signature, and immune landscape mediated by necroptosis-related genes in non-small cell lung cancer. Front Oncol 2022; 12:955186. [PMID: 35965497 PMCID: PMC9367639 DOI: 10.3389/fonc.2022.955186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNon-small cell lung cancer (NSCLC) is a highly heterogeneous malignancy with an extremely high mortality rate. Necroptosis is a programmed cell death mode mediated by three major mediators, RIPK1, RIPK3, and MLKL, and has been shown to play a role in various cancers. To date, the effect of necroptosis on NSCLC remains unclear.MethodsIn The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases, we downloaded transcriptomes of lung adenocarcinoma (LUAD) patients and their corresponding clinicopathological parameters. We performed multi-omics analysis using consensus clustering based on the expression levels of 40 necroptosis-related genes. We constructed prognostic risk models and used the receiver operating characteristic (ROC) curves, nomograms, and survival analysis to evaluate prognostic models.ResultsWith the use of consensus clustering analysis, two distinct subtypes of necroptosis were identified based on different mRNA expression levels, and cluster B was found to have a better survival advantage. Correlation results showed that necroptosis was significantly linked with clinical features, overall survival (OS) rate, and immune infiltration. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analysis confirmed that these differential genes were valuable in various cellular and biological functions and were significantly enriched in various pathways such as the P53 signaling pathway and cell cycle. We further identified three genomic subtypes and found that gene cluster B patients had better prognostic value. Multivariate Cox analysis identified the 14 best prognostic genes for constructing prognostic risk models. The high-risk group was found to have a poor prognosis. The construction of nomograms and ROC curves showed stable validity in prognostic prediction. There were also significant differences in tumor immune microenvironment, tumor mutational burden (TMB), and drug sensitivity between the two risk groups. The results demonstrate that the 14 genes constructed in this prognostic risk model were used as tumor prognostic biomarkers to guide immunotherapy and chemotherapy. Finally, we used qRT-PCR to validate the genes involved in the signature.ConclusionThis study promotes our new understanding of necroptosis in the tumor microenvironment of NSCLC, mines prognostic biomarkers, and provides a potential value for guiding immunotherapy and chemotherapy.
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Affiliation(s)
- Jiaqi Zhu
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Jinjie Wang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Tianyi Wang
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hao Zhou
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Mingming Xu
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Jiliang Zha
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Chen Feng
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Zihao Shen
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, and Research Institution of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yun Jiang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Jianle Chen, ; Yun Jiang,
| | - Jianle Chen
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Jianle Chen, ; Yun Jiang,
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A Ferroptosis-Related Gene Signature for Overall Survival Prediction and Immune Infiltration in Lung Squamous Cell Carcinoma. Biosci Rep 2022; 42:231598. [PMID: 35866375 PMCID: PMC9434561 DOI: 10.1042/bsr20212835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Ferroptosis is associated with cancer initiation and progression. However, the molecular mechanism and prognostic value of ferroptosis-related genes in lung squamous cell carcinoma (LUSC) are poorly understood. Methods: The mRNA expression profiles, methylation data, and clinical information of patients with LUSC were downloaded from TCGA and GEO database. Ferroptosis-related differentially expressed genes (DEGs) were identified between cancerous and non-cancerous tissues, and their prognostic value was systemically investigated by bioinformatic analyses. Results: A ferroptosis-related gene signature (ALOX5, TFRC, PHKG2, FADS2, NOX1) was constructed using multivariate Cox regression analysis and represented as a risk score. Overall survival (OS) probability was significantly lower in the high-risk group than in the low-risk group (P<0.001), and receiver operating characteristic curve showed a good predictive capacity (AUC = 0.739). The risk score was an independent prognostic factor for LUSC. A nomogram was constructed to predict the OS probabilities at 1, 3, and 5 years. High-risk score was associated with increased immune infiltration, lower methylation levels, higher immune checkpoint genes expression levels, and better chemotherapy response. Cell adhesion molecules, focal adhesion, and extracellular matrix receptor interaction were the main pathways in the high-risk group. The signature was validated using the TCGA test cohort, entire TCGA cohort, GSE30219, GSE157010, GSE73403, and GSE4573 datasets. The gene disorders in patients with LUSC were validated using real-time PCR and single-cell RNA sequencing analysis. Conclusions: A ferroptosis-related gene signature was constructed to predict OS probability in LUSC. This could facilitate novel therapeutic methods and guide individualized therapy.
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Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1115-1142. [PMID: 35705780 DOI: 10.1007/s11121-022-01388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.
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Affiliation(s)
- Alice Le Bonniec
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France.
| | - Sophie Sun
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Amandine Andrin
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Letrilliart
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
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Garg A, Iyer H, Jindal V, Vashistha V, Chawla G, Tiwari P, Mittal S, Madan K, Hadda V, Guleria R, Sati HC, Mohan A. Evaluation of delays during diagnosis and management of lung cancer in India: A prospective observational study. Eur J Cancer Care (Engl) 2022; 31:e13621. [DOI: 10.1111/ecc.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Avneet Garg
- Department of Pulmonary Medicine Adesh Institute of Medical Sciences and Research Bathinda India
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hariharan Iyer
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vinita Jindal
- Department of Radiology Adesh Institute of Medical Sciences and Research Bathinda India
| | - Vishal Vashistha
- Department of Hematology and Oncology New Mexico Veterans Affairs Medical Center Albuquerque New Mexico USA
- United States‐India Educational Foundation‐Nehru Senior Scholarship Program Delhi India
| | - Gopal Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Saurabh Mittal
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Karan Madan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vijay Hadda
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hem C. Sati
- Department of Biostatistics All India Institute of Medical Sciences Delhi India
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
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Saab MM, O'Driscoll M, FitzGerald S, Sahm LJ, Leahy-Warren P, Noonan B, Kilty C, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. Primary healthcare professionals' perspectives on patient help-seeking for lung cancer warning signs and symptoms: a qualitative study. BMC PRIMARY CARE 2022; 23:119. [PMID: 35585504 PMCID: PMC9114293 DOI: 10.1186/s12875-022-01730-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer incidence and mortality worldwide. Prompt patient help-seeking for signs and symptoms suggestive of lung cancer is crucial for early referral, diagnosis, and survivorship. However, individuals with potential lung cancer symptoms tend to delay help-seeking. This qualitative study explored perceived barriers to patient help-seeking and strategies to enhance help-seeking for lung cancer warning signs and symptoms from the perspective of primary healthcare professionals. METHODS Semi-structured focus groups and individual interviews were conducted with 36 primary healthcare professionals. Data were collected via videoconferencing. Inductive thematic analysis was conducted. RESULTS The following two themes were created from the data: (i) perceived barriers to patient help-seeking for signs and symptoms of concern and (ii) facilitating early patient presentation for signs and symptoms of concern. Some participants believed that the high cost of a general practitioner visit, long waiting times, and previous bad experiences with the healthcare system would deter patients from seeking help for symptoms of lung cancer. Perceived patient-related barriers to help-seeking related to the different emotions associated with a potential cancer diagnosis as well as stigma, embarrassment, and guilt felt by smokers. Sociodemographic factors such as drug use, homelessness, living in rural areas, and being male and older were also perceived to impede patient help-seeking. The negative impact of the COVID-19 pandemic on cancer help-seeking also featured strongly. Participants recommended several strategies to enable patients to seek help for symptoms of concern including targeted educational campaigns focussing on symptoms (e.g., cough) rather than behaviours (e.g., smoking), accessible and free health services, and using patients' support networks. CONCLUSIONS Patient-related and healthcare system-related barriers to help-seeking for lung cancer warning signs and symptoms include cost of healthcare, cancer fear, and various sociodemographic factors. Participants suggested that increased awareness and early patient help-seeking for symptoms of concern could be achieved through targeted patient education, national campaigns, the use of community support networks, and free and accessible targeted screening services.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland.
| | - Michelle O'Driscoll
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
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Sharman Moser S, Yaari S, Urban D, Apter L, Passwell N, Teper G, Chodick G, Siegelmann-Danieli N. Predictors of treatment initiation and mapping the cancer diagnostic pathway: A retrospective observational cohort study of patients with metastatic non-small cell lung cancer. Cancer Epidemiol 2022; 79:102156. [PMID: 35594797 DOI: 10.1016/j.canep.2022.102156] [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: 11/10/2021] [Revised: 01/26/2022] [Accepted: 03/31/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Health-care providers in the US revealed that a substantial proportion of mNSCLC patients do not receive any first-line therapy and the biggest gaps in care are time inefficiencies in the diagnostic process. The goal of this study was to determine whether such gaps are found in Israel where healthcare is universal and participation in a medical insurance plan is free and compulsory. METHODS We conducted a retrospective, observational cohort study using the computerized data of Maccabi Healthcare Services, a 2.5 million-member state-mandated health-service. Patients with mNSCLC diagnosed between 2017 and 2018 were followed until December 2019. RESULTS Among 434 patients (62% male, mean age 68 y, 74% adenocarcinoma), 345 (79%) initiated first-line treatment. Compared to treated, untreated patients (n = 89) were more likely to be older (mean [SD]=71 years [10] vs. 67 [10], p < 0.001), have a higher co-morbidity index (5.6 ([4.4] vs. 4.0 [3.4], p < 0.001), smokers (84% vs. 66%, p = 0.001), and require hospitalization in the year prior to diagnosis (80% vs 61%, p = 0.002). There was no difference in socioeconomic status. Time from first symptom to imaging was longer for untreated than treated patients (6.51 months [4.24, 7.33] vs 3.48 months [2.76, 4.34] respectively, p = 0.22). Predictors of treatment initiation included age< 70 years, non-smokers, EGFR testing performed, ECOG performance status 0-1 and shorter wait from first symptom to imaging. Median time from first symptom to initiation of 1 L, was 7.76 months (6.51-8.75). CONCLUSION The proportion of untreated mNSCLC patients are comparable to those reported in the US; we did not find health disparities between socioeconomic levels. Our data suggest that the main barrier to effective diagnostic process is the wait between symptom complaint and imaging.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel.
| | - Shira Yaari
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Damien Urban
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Lior Apter
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Netta Passwell
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Gally Teper
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nava Siegelmann-Danieli
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Ramsey AT, Baker TB, Stoneking F, Smock N, Chen J, Pham G, James AS, Colditz GA, Govindan R, Bierut LJ, Chen LS. Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics. J Natl Compr Canc Netw 2022; 20:488-495.e4. [PMID: 35545172 PMCID: PMC9173433 DOI: 10.6004/jnccn.2021.7333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment. METHODS This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods. RESULTS The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period. CONCLUSIONS A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.
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Affiliation(s)
- Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Aimee S. James
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A. Colditz
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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Hamdeh A, Househ M, Abd-alrazaq A, Muchori G, Al-saadi A, Alzubaidi M. Artificial Intelligence and the diagnosis of lung cancer in early stage: scoping review. (Preprint).. [DOI: 10.2196/preprints.38773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
Lung cancer is considered to be the most fatal out of all diagnoseable cancers. This is, in part, due to the difficulty in detecting lung cancer at an early stage. Moreover, approximately one in five individuals who will develop lung cancer will pass away due to a misdiagnosis. Fortunately, Machine Learning (ML) and Deep Learning (DL) is considered to be a promising solution for detection of lung cancer through developments in radiology.
OBJECTIVE
The purpose of this paper is to is to review how AI can assist identifying and diagnosing of lung cancer in an early stage.
METHODS
PRISMA was utilized and were retrieved from 4 databases: Google Scholar, PubMed, EMBASE, and Institute of Electrical and Electronics Engineers (IEEE). In addition, two phases of screening were implemented in order to determine relevant literature. The first phase was reading the title and abstract, and the second stage was reading the full text. These two steps were independently conducted by three reviewers. Finally, the three authors use a narrative synthesis to present the data.
RESULTS
Overall, 543 potential studies were extracted from four databases. After screening, 26 articles that met the inclusion criteria were included in this scoping review. Several articles utilized privet data including patients’ data and other public sources. 15 articles used data from UCI repository dataset (58%). However, CT scan images was utilized on 9 studies (normal CT was mentioned in 5 articles (19%), two studies used CT scan with PET (7.7%), and two articles used FDG with CT (7.7%). While two articles used demographic data such as age, sex, and educational background (7.7%).
CONCLUSIONS
This scoping review illustrates recent studies that utilize AI models to diagnose lung cancer. The literature currently relies on private and public databases and compare models with physicians or other machine learning technology. Additional studies should be conducted to explore the efficacy of these technologies in clinical settings.
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Integrative Analysis of m6A RNA Methylation Regulators and the Tumor Immune Microenvironment in Non-Small-Cell Lung Cancer. DISEASE MARKERS 2022; 2022:2989200. [PMID: 35186164 PMCID: PMC8849944 DOI: 10.1155/2022/2989200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/21/2022] [Indexed: 12/21/2022]
Abstract
Background Non-small-cell lung cancer (NSCLC) is a major component of lung cancer and is significantly correlated with poor prognosis. N6-methyladenosine (m6A) RNA methylation is closely related to the occurrence, progression, and prognosis of cancer. The potential biological functions and mechanisms of m6A RNA methylation in the immune microenvironment are still unclear. Methods We assessed m6A RNA methylation modification patterns in 1326 NSCLC patient samples based on 20 m6A regulators, linking these clusters to the tumor microenvironment and immune cell infiltration. The m6Ascore was created to quantify the m6A modification patterns of individual tumors. We then assessed the value of NSCLC patients in terms of clinical prognosis and immunotherapy response. Results According to different mRNA expression levels, two different m6A clusters were identified. m6A aggregation was significantly associated with clinical prognostic characteristics, the tumor microenvironment, and immune-related biological processes. Fifteen differential genes were screened based on these two m6A clusters, and to further investigate the mechanisms of action of these differential genes, they were subjected to unsupervised clustering analysis, which classified them into four different genomic isoforms. Prognostic analysis indicated that the survival advantage of the m6A gene cluster A modification mode was significantly prominent. We continued to construct the m6Ascore, which was used as a scoring tool to evaluate tumor typing, immunity, and prognosis. Patients with a low m6Ascore showed a significant survival advantage, and the group with a low m6Ascore had a better prognosis predicted by immunotherapy. The anti-PD-1/L1 immunotherapy cohort showed that a lower m6Ascore was associated with higher efficacy of immunotherapy. Conclusions The results suggest that m6A RNA methylation regulators make an important difference in the tumor immune microenvironment of patients with NSCLC. m6A gene characterization and the construction of the m6Ascore provide us with a richer understanding of m6A RNA methylation modification patterns in NSCLC patients and help to predict clinical prognosis and immunotherapeutic response.
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Hosseini K, Ranjbar M, Pirpour Tazehkand A, Asgharian P, Montazersaheb S, Tarhriz V, Ghasemnejad T. Evaluation of exosomal non-coding RNAs in cancer using high-throughput sequencing. J Transl Med 2022; 20:30. [PMID: 35033106 PMCID: PMC8760667 DOI: 10.1186/s12967-022-03231-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022] Open
Abstract
Clinical oncologists need more reliable and non-invasive diagnostic and prognostic biomarkers to follow-up cancer patients. However, the existing biomarkers are often invasive and costly, emphasizing the need for the development of biomarkers to provide convenient and precise detection. Extracellular vesicles especially exosomes have recently been the focus of translational research to develop non-invasive and reliable biomarkers for several diseases such as cancers, suggesting as a valuable source of tumor markers. Exosomes are nano-sized extracellular vesicles secreted by various living cells that can be found in all body fluids including serum, urine, saliva, cerebrospinal fluid, and ascites. Different molecular and genetic contents of their origin such as nucleic acids, proteins, lipids, and glycans in a stable form make exosomes a promising approach for various cancers' diagnoses, prediction, and follow-up in a minimally invasive manner. Since exosomes are used by cancer cells for intercellular communication, they play a critical role in the disease process, highlighting the importance of their use as clinically relevant biomarkers. However, regardless of the advantages that exosome-based diagnostics have, they suffer from problems regarding their isolation, detection, and characterization of their contents. This study reviews the history and biogenesis of exosomes and discusses non-coding RNAs (ncRNAs) and their potential as tumor markers in different types of cancer, with a focus on next generation sequencing (NGS) as a detection method. Moreover, the advantages and challenges associated with exosome-based diagnostics are also presented.
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Affiliation(s)
- Kamran Hosseini
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ranjbar
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Pirpour Tazehkand
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parina Asgharian
- Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheila Montazersaheb
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Tarhriz
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Tohid Ghasemnejad
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 PMCID: PMC9294071 DOI: 10.1097/ncc.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
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Lenze NR, Bensen JT, Farnan L, Sheth S, Zevallos JP, Yarbrough WG, Zanation AM. Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer. OTO Open 2021; 5:2473974X211065358. [PMID: 34926976 PMCID: PMC8671675 DOI: 10.1177/2473974x211065358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an academic tertiary care center. Methods Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self-reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT-GP). Results The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty-two percent were male and 87% were White. Sixty-two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years ( P = .007), female sex ( P = .020), being unmarried ( P = .016), being uninsured ( P = .047), and Medicaid insurance ( P = .022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires ( P < .001 and P = .002, respectively) and lower cancer-specific HRQOL on the FACT-GP questionnaire ( P < .001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5-year OS (75.3% vs 84.1%, P = .177) or 5-year CSS (81.6% vs 85.4%, P = .542) in patients with and without barriers to care. Conclusion Delay- and affordability-related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient-reported barriers to care.
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Affiliation(s)
- Nicholas R. Lenze
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jose P. Zevallos
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Wendell G. Yarbrough
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Pathology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam M. Zanation
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Joyce K, Zermanos T, Badrinath P. Factors associated with variation in emergency diagnoses of cancer at general practice level in England. J Public Health (Oxf) 2021; 43:e593-e600. [PMID: 32888030 DOI: 10.1093/pubmed/fdaa142] [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] [Received: 11/26/2019] [Revised: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer patients diagnosed following an emergency presentation have poorer outcomes. We explore whether practice characteristics are associated with differences in the proportion of emergency presentations. METHODS Univariable and multivariable logistic regression models were fitted to investigate the relationships between 2017-18 emergency cancer presentations at practice level in England and access and continuity in primary care, trust in healthcare professionals, 2-week-wait (2WW) referrals, quality and outcomes framework (QOF) achievements and socio-demographic factors (age, gender and deprivation). RESULTS Our analysis using comprehensive nationwide data found that the following practice level factors have significant associations with a lower proportion of emergency diagnosis of cancer: increased trust and confidence in the practice healthcare professionals; higher 2WW referral and conversion rate; higher total practice QOF score and higher satisfaction with appointment times or higher proportion able to see preferred GP. Our results also show that practices in more deprived areas are significantly associated with a higher proportion of emergency diagnoses of cancer. CONCLUSIONS Regional cancer networks should focus their efforts in increasing both the quantity and appropriateness of 2WW referrals from primary care. In addition, primary care clinicians should be supported to undertake high quality consultations, thus building trust with patients and ensuring continuity of care.
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Affiliation(s)
- Kevin Joyce
- Suffolk County Council and West Suffolk Foundation Trust, Suffolk, IP33 2QZ, UK
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Boakye D, Günther K, Niedermaier T, Haug U, Ahrens W, Nagrani R. Associations between comorbidities and advanced stage diagnosis of lung, breast, colorectal, and prostate cancer: A systematic review and meta-analysis. Cancer Epidemiol 2021; 75:102054. [PMID: 34773768 DOI: 10.1016/j.canep.2021.102054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/20/2022]
Abstract
Comorbidities and advanced stage diagnosis (ASD) are both associated with poorer cancer outcomes, but the association between comorbidities and ASD is poorly understood. We summarized epidemiological evidence on the association between comorbidities and ASD of selected cancers in a systematic review and meta-analysis. We searched PubMed and Web of Science databases up to June 3rd, 2021 for studies assessing the association between comorbidities and ASD of lung, breast, colorectal, or prostate cancer. Summary odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random-effects models. Also, potential variations in the associations between comorbidities and ASD by cancer type were investigated using random-effects meta-regression. Thirty-seven studies were included in this review, including 8,069,397 lung, breast, colorectal, and prostate cancer patients overall. The Charlson comorbidity index score was positively associated with ASD (stages III-IV) of breast cancer but was inversely associated with ASD of lung cancer (pinteraction = 0.004). Regarding specific comorbidities, diabetes was positively associated with ASD (OR = 1.17, 95%CI = 1.09-1.26), whereas myocardial infarction was inversely associated with ASD (OR = 0.84, 95%CI = 0.75-0.95). The association between renal disease and ASD differed by cancer type (pinteraction < 0.001). A positive association was found with prostate cancer (OR = 2.02, 95%CI = 1.58-2.59) and an inverse association with colorectal cancer (OR = 0.84, 95%CI = 0.70-1.00). In summary, certain comorbidities (e.g., diabetes) may be positively associated with ASD of several cancer types. It needs to be clarified whether closer monitoring for early cancer signs or screening in these patients is reasonable, considering the problem of over-diagnosis particularly relevant in patients with short remaining life expectancy such as those with comorbidities. Also, evaluation of the cost-benefit relationship of cancer screening according to the type and severity of comorbidity (rather than summary scores) may be beneficial for personalized cancer screening in populations with chronic diseases.
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Affiliation(s)
- Daniel Boakye
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Kathrin Günther
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Rajini Nagrani
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Implementing and Sustaining Early Cancer Diagnosis Initiatives in Canada: An Exploratory Qualitative Study. Curr Oncol 2021; 28:4341-4356. [PMID: 34898549 PMCID: PMC8628805 DOI: 10.3390/curroncol28060369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The interval between suspected cancer and diagnosis for symptomatic patients is often fragmented, leading to diagnosis delays and increased patient stress. We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining current initiatives across Canada that optimize early cancer diagnosis, with particular relevance for symptomatic patients. Methods: The national study included a document review and key informant interviews with purposefully recruited participants. Data were analyzed by two researchers using descriptive statistics and thematic analysis. Results: Twenty-two participants from eight provinces participated in key informant interviews and reported on 17 early cancer diagnosis initiatives. Most initiatives (88%) were in early phases of implementation. Two patient-facing and eight provider/organization barriers to implementation (e.g., lack of stakeholder buy-in and limited resources) and five facilitators for implementation and sustainability were identified. Opportunities to improve early cancer diagnosis initiatives included building relationships with stakeholders, co-creating initiatives, developing initiatives for Indigenous and underserved populations, optimizing efficiency and sustainability, and standardizing metrics to evaluate impact. Conclusion: Early cancer diagnosis initiatives in Canada are in early implementation phases. Lack of stakeholder buy-in and limited resources pose a challenge to sustainability. We present opportunities for funders and policymakers to optimize the use and potential impact of early cancer diagnosis initiatives.
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Petersen GS, Laursen SGW, Jensen H, Maindal HT, Pedersen AF, Vedsted P, Virgilsen LF. Patients' health literacy is associated with timely diagnosis of cancer-A cross-sectional study in Denmark. Eur J Cancer Care (Engl) 2021; 31:e13532. [PMID: 34704640 DOI: 10.1111/ecc.13532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Timely diagnosis of cancer is important for prognosis. Patients' health literacy (HL) may impact differences of diagnostic delays. Thus, we aim to explore the association between HL and diagnostic intervals in cancer. METHODS Questionnaire data were obtained from patients with cancer diagnosed in 2016 and their general practitioner (n = 3890). The primary care interval (PCI) and the diagnostic interval (DI) were calculated using dates from national registries and questionnaires. A long PCI and DI were defined as ≥75th percentile. HL was assessed using scales from the Health Literacy Questionnaire: engaging with healthcare providers (scale 6:Engagement, n = 3008), navigating in healthcare (scale 7:Navigation, n = 2827) and understanding health information (scale 9:Knowledge, n = 3002). Low HL was defined as a score ≤3. RESULTS Low HL was reported by 12.2% (Engagement), 27.0% (Navigation) and 9.3% (Knowledge) of the patients and associated with a long PCI after adjustment of socio-economic factors: Engagement (prevalence rate ratio [PRR] 1.27 [95% CI 1.01-1.60]), Navigation (PRR 1.41 [95% CI 1.10-1.80]) and Knowledge (PRR 1.32 [95% CI 1.03-1.68]). No association was found between HL and DI. CONCLUSION HL may interfere with the diagnostic processes in general practice. Efforts to manage low HL include GPs' awareness of patients' ability to explain and respond to bodily changes and use of corresponding safety-netting strategies.
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Affiliation(s)
| | | | - Henry Jensen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | | | - Anette F Pedersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
| | - Line Flytkjaer Virgilsen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus, Denmark
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Zhou H, Zheng M, Shi M, Wang J, Huang Z, Zhang H, Zhou Y, Shi J. Characteristic of molecular subtypes in lung adenocarcinoma based on m6A RNA methylation modification and immune microenvironment. BMC Cancer 2021; 21:938. [PMID: 34416861 PMCID: PMC8379743 DOI: 10.1186/s12885-021-08655-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) is a major subtype of lung cancer and closely associated with poor prognosis. N6-methyladenosine (m6A), one of the most predominant modifications in mRNAs, is found to participate in tumorigenesis. However, the potential function of m6A RNA methylation in the tumor immune microenvironment is still murky. METHODS The gene expression profile cohort and its corresponding clinical data of LUAD patients were downloaded from TCGA database and GEO database. Based on the expression of 21 m6A regulators, we identified two distinct subgroups by consensus clustering. The single-sample gene-set enrichment analysis (ssGSEA) algorithm was conducted to quantify the relative abundance of the fraction of 28 immune cell types. The prognostic model was constructed by Lasso Cox regression. Survival analysis and receiver operating characteristic (ROC) curves were used to evaluate the prognostic model. RESULT Consensus classification separated the patients into two clusters (clusters 1 and 2). Those patients in cluster 1 showed a better prognosis and were related to higher immune scores and more immune cell infiltration. Subsequently, 457 differentially expressed genes (DEGs) between the two clusters were identified, and then a seven-gene prognostic model was constricted. The survival analysis showed poor prognosis in patients with high-risk score. The ROC curve confirmed the predictive accuracy of this prognostic risk signature. Besides, further analysis indicated that there were significant differences between the high-risk and low-risk groups in stages, status, clustering subtypes, and immunoscore. Low-risk group was related to higher immune score, more immune cell infiltration, and lower clinical stages. Moreover, multivariate analysis revealed that this prognostic model might be a powerful prognostic predictor for LUAD. Ultimately, the efficacy of this prognostic model was successfully validated in several external cohorts (GSE30219, GSE50081 and GSE72094). CONCLUSION Our study provides a robust signature for predicting patients' prognosis, which might be helpful for therapeutic strategies discovery of LUAD.
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Affiliation(s)
- Hao Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University and Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Miaosen Zheng
- Department of Pathology, Affiliated Hospital of Nantong University and Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Muqi Shi
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Jinjie Wang
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University and Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Zhanghao Huang
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University and Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Haijian Zhang
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Youlang Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Jiahai Shi
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University and Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
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Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health 2021; 26:1177-1188. [PMID: 34219346 DOI: 10.1111/tmi.13651] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. METHODS An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool. RESULTS Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs. CONCLUSIONS As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis. PLoS One 2021; 16:e0252529. [PMID: 34086757 PMCID: PMC8177459 DOI: 10.1371/journal.pone.0252529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal. METHODS Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0). RESULTS Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals. CONCLUSIONS Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.
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Filipska M, Rosell R. Mutated circulating tumor DNA as a liquid biopsy in lung cancer detection and treatment. Mol Oncol 2021; 15:1667-1682. [PMID: 33969622 PMCID: PMC8169447 DOI: 10.1002/1878-0261.12983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, substantial developments have been made in the detection of circulating tumor DNA (ctDNA)-cell-free DNA (cfDNA) fragments released into the circulation from tumor cells and displaying the genetic alterations of those cells. As such, ctDNA detected in liquid biopsies serves as a powerful tool for cancer patient stratification, therapy guidance, detection of resistance, and relapse monitoring. In this Review, we describe lung cancer diagnosis and monitoring strategies using ctDNA detection technologies and compile recent evidence regarding lung cancer-related mutation detection in liquid biopsy. We focus not only on epidermal growth factor receptor (EGFR) alterations, but also on significant co-mutations that shed more light on novel ctDNA-based liquid biopsy applications. Finally, we discuss future perspectives of early-cancer detection and clonal hematopoiesis filtering strategies, with possible inclusion of microbiome-driven liquid biopsy.
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Affiliation(s)
- Martyna Filipska
- Germans Trias i Pujol Research Institute and HospitalBadalonaSpain
- Autonomous University of BarcelonaCerdanyola del VallesSpain
| | - Rafael Rosell
- Germans Trias i Pujol Research Institute and HospitalBadalonaSpain
- Autonomous University of BarcelonaCerdanyola del VallesSpain
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