Cultural factors associated with racial disparities in lung cancer care.

Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity.

Objectives: To determine cultural factors associated with disparities in lung cancer treatment.

Inequalities in lung cancer care of elderly patients with schizophrenia: an observational cohort study.

Objective: Cancer mortality is higher in individuals with schizophrenia, a finding that may be due, in part, to inequalities in care. We evaluated gaps in lung cancer diagnosis, treatment, and survival among elderly individuals with schizophrenia.

Methods: The Surveillance, Epidemiology, and End Results database linked to Medicare records was used to identify patients 66 years or older with primary non-small cell lung cancer.

Comparative outcomes of elderly stage I lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection.

Introduction: Video-assisted thorcacic surgery (VATS) is considered an alternative to open lobectomy for the treatment of non-small-cell lung cancer (NSCLC). Limited data are available, however, regarding the equivalence of open versus VATS segmental resections, particularly among elderly patients.

Methods: From the Surveillance, Epidemiology, and End Results-Medicare database we identified 577 stage I NSCLC patients aged more than 65 years treated with VATS or open segmentectomy.

Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening.

Background: HIV-infected persons have a two-fold to five-fold increased unadjusted risk of lung cancer. In the National Lung Screening Trial (NLST), computed tomography (CT) screening was associated with a reduction in lung cancer mortality among high-risk smokers. These results may not generalize to HIV-infected persons, particularly if they are more likely to have false-positive chest CT findings.

Adverse event reporting in cancer clinical trial publications.

Purpose: Reporting adverse events is a critical element of a clinical trial publication. In 2003, the Consolidated Standards of Reporting Trials (CONSORT) group generated recommendations regarding the appropriate reporting of adverse events. The degree to which these recommendations are followed in oncology publications has not been comprehensively evaluated.

Metered dose inhaler technique among inner-city asthmatics and its association with asthma medication adherence.

Introduction: Inhaled medications, critical for asthma treatment, are self-administered through metered dose inhalers (MDI). Asthma self-management hinges on adherence to these medications and to proper MDI technique.

Objective: To assess predictors of proper MDI technique, and MDI technique as a tool to identify patients with low adherence to inhaled medications.

Breast density: comparison of chest CT with mammography.

Purpose: To (a) perform a pilot study comparing radiologists' reading of breast density at computed tomography (CT) of the chest with breast density readings from mammography performed in the same patient and (b) compare a subset of these with computer-derived measurements of breast density at CT.

Materials And Methods: The institutional review board waived informed consent for this HIPAA-compliant retrospective review of mammograms and chest CT scans from 206 women obtained within 1 year of each other. Two radiologists with expertise in interpreting mammographic and CT findings independently reviewed the mammograms and CT scans and classified each case into one of the four breast density types defined by the Breast Imaging Reporting and Data System of the American College of Radiology.

Racial disparities in the treatment of advanced epithelial ovarian cancer.

Objective: To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer.

Methods: We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or stage IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison.

Asthma outcomes are poor among older adults with low health literacy.

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics.

Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1 s (FEV1) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life.

Revised staging classification improves outcome prediction for small intestinal neuroendocrine tumors.

Purpose: Small intestinal (SI) neuroendocrine tumors (NETs) have heterogeneous outcomes. The NET societies have recently proposed a TNM staging classification. In this study, we used population-based data to assess the validity of the staging system.

Adjuvant treatment for elderly patients with early-stage lung cancer treated with limited resection.

Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established.

Prognosis in HIV-infected patients with non-small cell lung cancer.

Background: We conducted a population-based study to evaluate whether non-small cell lung cancer (NSCLC) prognosis was worse in HIV-infected compared with HIV-uninfected patients.

Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare claims, we identified 267 HIV-infected patients and 1428 similar controls with no evidence of HIV diagnosed with NSCLC between 1996 and 2007. We used conditional probability function (CPF) analyses to compare survival by HIV status accounting for an increased risk of non-lung cancer death (competing risks) in HIV-infected patients.

Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer.

Purpose: Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients.

Plasma level of interferon γ induced protein 10 is a marker of sarcoidosis disease activity.

Rationale: Sarcoidosis is an idiopathic granulomatous disorder with heterogeneous clinical manifestations and variable prognosis. Monitoring disease activity is important to identify patients requiring treatment. Several cytokines have previously been shown to be elevated in the serum of patients with sarcoidosis and may be useful biomarkers of disease activity.

Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial.

Importance: There is consensus that incorporating clinical decision support into electronic health records will improve quality of care, contain costs, and reduce overtreatment, but this potential has yet to be demonstrated in clinical trials.

Objective: To assess the influence of a customized evidence-based clinical decision support tool on the management of respiratory tract infections and on the effectiveness of integrating evidence at the point of care.

Design, Setting, And Participants: In a randomized clinical trial, we implemented 2 well-validated integrated clinical prediction rules, namely, the Walsh rule for streptococcal pharyngitis and the Heckerling rule for pneumonia.

Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer.

Background: Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early-stage non-small cell lung cancer (NSCLC). However, the benefits of complete lymphadenectomy are unproven. There is evidence suggesting a predictable pattern of mediastinal nodal drainage.

Supraventricular arrhythmias in patients with cardiac sarcoidosis prevalence, predictors, and clinical implications.

Background: Cardiac sarcoidosis (CS) is known to be associated with congestive heart failure, conduction disorders, and tachyarrhythmias. Ventricular arrhythmias are the most feared cardiac manifestation because they often are unpredictable, may be the fi rst manifestation of the disease, and may be fatal. The propensity for the development of supraventricular arrhythmias (SVAs) in patients with CS has not been described.

Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

Background: Bronchial intraepithelial lesions may be precursors of central airway lung carcinomas. Identification and early treatment of these preinvasive lesions might prevent progression to invasive carcinoma.

Methods: We systematically reviewed the literature to develop evidence-based recommendations regarding the diagnosis and treatment of intraepithelial lesions.

The association of health literacy with illness and medication beliefs among older adults with asthma.

Objective: Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs.

Methods: Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420).

Depressive symptoms, low adherence, and poor asthma outcomes in the elderly.

Objective: To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma.

Methods: Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patient Health Questionnaire (PHQ-9).

Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: a SEER analysis.

Purpose: Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an "evidence void" regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx.

Evaluating beliefs associated with late-stage lung cancer presentation in minorities.

Introduction: Minority patients in the United States present with later stages of lung cancer and have poorer outcomes. Cultural factors, such as beliefs regarding lung cancer and discrimination experiences, may underlie this disparity.

Methods: Patients with a new diagnosis of lung cancer were recruited from four medical centers in New York City.

Survival after segmentectomy and wedge resection in stage I non-small-cell lung cancer.

Introduction: Although lobectomy is considered the standard surgical treatment for stage IA non-small-cell lung cancer (NSCLC), wedge resection or segmentectomy are frequently performed on patients who are not lobectomy candidates. The objective of this study was to compare survival among patients with stage IA NSCLC, who are undergoing these procedures.

Methods: Using the Surveillance, Epidemiology and End Results registry, we identified 3525 patients.

Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease.

Background: The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients.

Methods: Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007.

Polysomnographic diagnoses among former world trade center rescue workers and volunteers.

An increased risk for obstructive sleep apnea (OSA) has been suggested for World Trade Center (WTC)-exposed workers. The authors reviewed the results from nocturnal polysomnograms (PSGs), to investigate diagnostic differences between WTC-exposed and -unexposed subjects. Six hundred fifty-six nocturnal PSGs performed at our sleep center were reviewed, 272 of them in former WTC workers.