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Laguna JC, Tagliamento M, Lambertini M, Hiznay J, Mezquita L. Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes. Am Soc Clin Oncol Educ Book 2024; 44:e432488. [PMID: 38788188 DOI: 10.1200/edbk_432488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.
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Affiliation(s)
- Juan Carlos Laguna
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Choi YY, Lee M, Kim EH, Lee JE, Jung I, Cheong JH. Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e48380. [PMID: 38717807 PMCID: PMC11112468 DOI: 10.2196/48380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/19/2023] [Accepted: 03/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase. OBJECTIVE We evaluated the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age. METHODS We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population. RESULTS Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26% lower risk of developing SPCs (SIR 0.74, 95% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28% higher in young (<40 years) cancer survivors (SIR 1.28, 95% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27% lower in middle-aged and older (≥40 years) cancer survivors (SIR 0.73, 95% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6%) and prostate (15.2%) cancers in men and breast (18.9%) and lung (12.2%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors. CONCLUSIONS The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs.
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Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon si, Republic of Korea
| | - Myeongjee Lee
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Eun Lee
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inkyung Jung
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
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Nash J, Leong T, Dawkins P, Stone E, Marshall H, Brims F. The TSANZ and Lung Foundation Australia 2023 landscape survey of lung cancer care across Australia and Aotearoa New Zealand. Respirology 2024; 29:405-412. [PMID: 38431910 DOI: 10.1111/resp.14693] [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: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Unwarranted variations in lung cancer care have been well described in both Australia and Aotearoa New Zealand, with shortfalls in hospital-based workforce and infrastructure previously demonstrated. A survey of lung cancer clinicians was performed to gain an updated understanding of current workforce and infrastructure. METHODS An online Qualtrics survey included questions on institutional demographics, estimated lung cancer case load, multidisciplinary team (MDT) characteristics including workforce and local infrastructure. We sought to obtain one response from every institution treating lung cancer in Australia and Aotearoa New Zealand. RESULTS Responses were received from 89 institutions, estimated to include 85% centres treating lung cancer in Australia and 100% of public hospitals in Aotearoa New Zealand. Lung cancer nurse specialist and Nuclear Medicine are poorly represented in multidisciplinary teams (MDTs) with just 34/88 (38%) institutions fulfilling recommended core workforce for MDT meetings. Case presentation is low with 32/88 (36%) regularly discussing all lung cancer patients at MDT. Metropolitan institutions appear to have a more comprehensive range of services on site, compared to non-metropolitan institutions. Few (4/88) institutions have embedded smoking cessation services. Compared to the previous 2021 Landscape Survey, thoracic surgery representation and core MDT workforce have improved, with modest change in specialist nurse numbers. CONCLUSION This wide-reaching survey has identified persistent deficiencies and variations in lung cancer workforce and gaps in infrastructure. Multidisciplinary collaboration and care coordination are needed to ensure all patients can access timely and equitable lung cancer care.
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Affiliation(s)
- Jessica Nash
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Dawkins
- Middlemore Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Fraser Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Institute for Respiratory Health, Perth, Western Australia, Australia
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Bade BC, Zhao J, Li F, Tanoue L, Lazowski H, Alfano CM, Silvestri GA, Irwin ML. Trends and predictors of Quality of Life in lung cancer survivors. Lung Cancer 2024; 191:107793. [PMID: 38640687 DOI: 10.1016/j.lungcan.2024.107793] [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: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Health-related quality of life (HR-QoL) is often impaired in lung cancer survivors. To inform personalized survivorship care, we identified associations between HR-QoL scores and patient-, tumor-, and treatment-factors over time. MATERIALS AND METHODS We evaluated HR-QoL scores provided at diagnosis, 6 months, 1 year, and 2 years from the Yale Lung Cancer Biorepository. HR-QoL was measured via the Functional Assessment of Cancer Therapy - Lung (FACT-L) instrument and available for a subset of patients (n = 513). Analyses were stratified by early-stage (I-II; n = 355) non-small cell lung cancer (NSCLC), advanced stage NSCLC (III-IV; n = 158), and small cell lung cancer (SCLC, n = 21). We used mixed effects modeling and multivariable analysis with covariate adjustment to examine changes in FACT-L from diagnosis to follow-up. Sensitivity analysis was performed including patients with early-stage disease and complete FACT-L scores at both baseline and year 2 (n = 91). RESULTS The average FACT-L scores at diagnosis in early-stage NSCLC, advanced stage NSCLC, and SCLC were 121.0 (standard deviation (SD) 11.4), 109.2 (18.7), and 98.7 (20.2) respectively. At all timepoints, HR-QoL was higher in patients with early-stage NSCLC (vs advanced-stage disease). In patients with early- and advanced-stage NSCLC, HR-QoL was higher at years 1 and 2 than at diagnosis, though the changes did not meet clinical significance. At NSCLC diagnosis, higher HR-QoL was associated with older age, better performance status, participating in physical activity, adenocarcinoma histology, and (in advanced stage NSCLC) anticipated treatment with chemotherapy. At NSCLC follow-up, HR-QoL was higher in patients with higher BMI and better performance status. DISCUSSION In patients with newly diagnosed NSCLC, HR-QoL scores are impacted by patient factors, tumor factors, and treatment factors. HR-QoL is higher in patients with early-stage disease. In patients surviving 2 years, HR-QoL was higher at follow-up, though the change did not meet clinical significance. To optimize HR-QoL, lung cancer survivorship teams should prioritize comorbidity management, physical activity, healthy weight maintenance, and treatment-related side effects.
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Affiliation(s)
- Brett C Bade
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Institute of Health System Science, Feinstein Institutes for Medical Research; Northwell Health Cancer Institute.
| | | | | | - Lynn Tanoue
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; Yale Cancer Center, Yale School of Medicine
| | | | - Catherine M Alfano
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Institute of Health System Science, Feinstein Institutes for Medical Research; Northwell Health Cancer Institute
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Medical University of South Carolina
| | - Melinda L Irwin
- Yale Cancer Center, Yale School of Medicine; Department of Chronic Disease Epidemiology, Yale University School of Public Health
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Lai H, Liu Q, Ye Q, Liang Z, Long Z, Hu Y, Wu Q, Jiang M. Impact of smoking cessation duration on lung cancer mortality: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 196:104323. [PMID: 38462148 DOI: 10.1016/j.critrevonc.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/11/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Smoking history is a heterogeneous situation for different populations, and numerous studies suggest that smoking cessation is conducive to reduce the mortality of lung cancer. However, no quantitative meta-analysis regarding smoking cessation duration based on different populations has demonstrated it clearly. METHODS We systematically searched four electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scoups) till February 2023. Eligible studies reported the association between lung cancer survival and duration of smoking cessation. Additionally, we stratified the study population according to whether they had lung cancer at the time they quit smoking. Studies were pooled with the random-effects model. RESULTS Out of the 11,361 potential studies initially identified, we included 24 studies involving 969,560 individuals in our analysis. Lung cancer mortality varied across two groups: general quitters and peri-diagnosis quitters. For general quitters, those who had quit smoking for less than 10 years exhibited an RR of 0.64 (95% CI [0.55-0.76]), while those who quit for 10-20 years had an RR of 0.33 (0.25-0.43), over 20 years had an RR of 0.16 (0.11-0.24), and never-smokers had an RR at 0.11 (0.07-0.15). Among peri-diagnosis quitters, the 1-year Overall Survival (OS) showed an RR of 0.80 (0.67-0.96), the 2-year OS had an RR of 0.89 (0.80-0.98), the 3-year OS had an RR of 0.93 (0.84-1.03), and the 5-year OS had an RR of 0.85 (0.76-0.96). CONCLUSIONS Earlier and longer smoking cessation is associated with reduced lung cancer mortality, no matter in which cessation stage for two different populations.
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Affiliation(s)
- Hongkun Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Quanzhen Liu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Qianxian Ye
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Ziyang Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Zhiwei Long
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Yinghong Hu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Qianlong Wu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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Raspe M, Lo K, Sommer N, Andreas S. [Tobacco cessation: one of the most effective medical measures]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:365-375. [PMID: 38446181 DOI: 10.1007/s00108-024-01683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
Tobacco smoking is widespread in Germany. An increase in the number of teenagers and young adults that smoke has recently been a cause for concern. The high prevalence in Germany is contrasted by inadequate preventive measures compared to international standards. Smoking behavior should always be inquired about and documented in the same way as vital signs. All smokers, regardless of the reason for contact and motivation, should receive short, low-threshold advice, e.g. using the ABC approach (ask, brief advice, cessation). In addition to repeated advice and referral to further services, the use of nicotine replacement or drug therapy is essential for the success of quitting. The combination of long- and short-acting nicotine replacement products doubles the success rate. Electronic nicotine delivery systems are not recommended for smoking cessation.
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Affiliation(s)
- Matthias Raspe
- Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Kevin Lo
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Natascha Sommer
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Stefan Andreas
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
- Lungenfachklinik Immenhausen, Robert-Koch-Straße 3, 34376, Immenhausen, Deutschland
- Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Lewis KE. Smoking cessation at lung cancer screening: joining (life-saving) dots. Eur Respir J 2024; 63:2400550. [PMID: 38636975 DOI: 10.1183/13993003.00550-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Keir E Lewis
- School of Medicine, Faculty of Health Sciences, University of Swansea, Swansea, UK
- Department of Respiratory Medicine, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli, UK
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Zhu J, Branstetter S, Lazarus P, Muscat JE. Smoking, Lung Cancer Stage, and Prognostic Factors-Findings from the National Lung Screening Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:400. [PMID: 38673313 PMCID: PMC11050078 DOI: 10.3390/ijerph21040400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) increases the early detection of lung cancer. Identifying modifiable behaviors that may affect tumor progression in LDCT-detected patients increases the likelihood of long-term survival and a good quality of life. METHODS We examined cigarette smoking behaviors on lung cancer stage, progression, and survival in 299 ever-smoking patients with low-dose CT-detected tumors from the National Lung Screening Trial. Univariate and multivariate Cox models were used to estimate the hazard ratio (HR) for smoking variables on survival time. RESULTS Current vs. former smokers and early morning smokers (≤5 min after waking, i.e., time to first cigarette (TTFC) ≤ 5 min) had more advanced-stage lung cancer. The adjusted HR for current vs. former smokers was 1.3 (95% confidence interval [CI] 0.911-1.98, p = 0.136) for overall survival (OS) and 1.3 (0.893-1.87, p = 0.1736) for progression-free survival (PFS). The univariate hazard ratios for TTFC ≤ 5 min vs. >5 min were 1.56 (1.1-2.2, p = 0.013) for OS and 1.53 (1.1-2.12, p = 0.01) for PFS. Among current smokers, the corresponding HRs for early TTFC were 1.78 (1.16-2.74, p = 0.0088) and 1.95 (1.29-2.95, p = 0.0016) for OS and PFS, respectively. In causal mediation analysis, the TTFC effect on survival time was mediated entirely through lung cancer stage. CONCLUSION The current findings indicate smoking behaviors at diagnosis may affect lung cancer stage and prognosis.
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Affiliation(s)
- Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Steven Branstetter
- Department of Biobehavioral Heath, Penn State University, University Park, PA 16802, USA;
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA;
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
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Fucito LM, Palmer AM, Baldassarri SR. A new perspective on mitigating lung cancer risks through smoking cessation and reduction. J Natl Cancer Inst 2024:djae044. [PMID: 38497951 DOI: 10.1093/jnci/djae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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Lan Y, Lin X, Yu J, Wang L, Sun L, Huang Z. Assessment of the implementation of accelerated drug marketing registration procedures for antineoplastic and immunomodulating agents in China: based on 2016-2022 review data. Front Pharmacol 2024; 15:1345672. [PMID: 38562467 PMCID: PMC10982497 DOI: 10.3389/fphar.2024.1345672] [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: 11/28/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Since 2016, China has successively implemented Accelerated Drug Marketing Registration Procedures (ADMRPs) for drugs, including Breakthrough Therapy Drug (BTD), Conditional Approval (CA), and Priority Review and Approval (PRA), which have played an important role in promoting the development and review of clinically urgently needed drugs. In this study, we focused on the antineoplastic and immunomodulating agents approved for marketing through ADMRPs, to provide a reference for promoting the formation of a stable and mature regulatory system for the review and approval of antineoplastic drugs and immunomodulating agents in China. Methods Reviewed the National Medical Products Administration (NMPA) drug review reports for the years 2016-2022 and screened the antineoplastic and immunomodulating agents approved through ADMRPs. Then, with the help of the NMPA website and the Yaozhi Database, two researchers independently queried and entered the detailed information of the selected drugs, and checked with each other. The attribute classification and main characteristics of the drugs were then analyzed with descriptive statistics to obtain the trend of drug types, drug review and approval status, and timeliness. Results A total of 206 antineoplastic and immunomodulating agents were approved for marketing through five accelerated marketing registration procedures (or procedure combinations), with the average review time shortened by about 81 days. Among them, imported drugs accounted for a larger proportion, the most drugs for treating non-small cell lung cancer and lymphoma, and the largest number of PD-1/PDL-1 inhibitors, but pediatric drugs and rare disease drugs accounted for a smaller proportion. Conclusion ADMRPs can promote the accessibility of antineoplastic and immunomodulating agents in China and safeguard the life and health rights of more patients. Nevertheless, it is necessary to pay attention to the expansion of the types of indications for medicines and to increase the development of drugs that are urgently needed by a small number of patients.
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Affiliation(s)
- Yipeng Lan
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Xiaofeng Lin
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Jialin Yu
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Li Wang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China
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Scholten PR, Stalpers LJA, Bronsema I, van Os RM, Westerveld H, van Lonkhuijzen LRCW. The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis. J Cancer Policy 2024; 39:100463. [PMID: 38065242 DOI: 10.1016/j.jcpo.2023.100463] [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: 09/11/2023] [Revised: 11/11/2023] [Accepted: 12/03/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVES patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer. METHODS PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis. RESULTS A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24-2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 - 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69-1.78, p = 0.66). CONCLUSION A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.
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Affiliation(s)
- Peter R Scholten
- Center for Gynaecologic Oncology Amsterdam, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Lukas J A Stalpers
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Iris Bronsema
- Center for Gynaecologic Oncology Amsterdam, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rob M van Os
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Henrike Westerveld
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecologic Oncology Amsterdam, Amsterdam UMC, University of Amsterdam, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Jørgensen CU, Løkke A, Hjorth P, Pisinger C, Farver-Vestergaard I. Barriers to implementation of smoking cessation support among healthcare professionals in the secondary healthcare sector: A qualitative and quantitative evaluation. Tob Prev Cessat 2024; 10:TPC-10-12. [PMID: 38389587 PMCID: PMC10882562 DOI: 10.18332/tpc/183775] [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: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Smoking cessation support (SCS) in the hospital is essential; patients often struggle to maintain quit attempts, which necessitates assistance from healthcare professionals (HCPs). However, unknown barriers can obstruct the implementation of SCS in hospitals. This study aims to uncover barriers to the implementation of SCS in psychiatric, somatic, inpatient, and outpatient hospital settings. METHODS In the period from June to September 2021, HCPs in a large secondary care hospital in the Region of Southern Denmark completed an online, cross-sectional study, providing sociodemographic details and listing potential barriers to SCS. They also shared additional barriers in the form of free-text responses. Descriptive statistics and thematic analysis of free-text responses were performed. RESULTS Of 1645 HCPs surveyed, 409 elaborated their response in the free-text field assessing unlisted barriers. Top listed barriers, reported by more than one-third of participants, included: 'lack of time' (45.1%), 'lack of patient motivation' (34.3%), and 'insufficient knowledge on how to support' (32.2%). Free-text responses revealed three barrier-related, which we grouped under the themes of: 'Concerned about the patient', 'Not part of my job', and 'Inappropriate setting'. CONCLUSIONS This quantitative and qualitative study identifies barriers to SCS on multiple levels in the hospital setting, i.e. on the patient, provider, and organizational levels. These results can inform healthcare organizations and professionals in the implementation of SCS in routine hospital care.
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Affiliation(s)
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Hjorth
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Psychiatric Department, Mental Health Services, University Hospital of Southern Denmark, Odense, Denmark
| | - Charlotta Pisinger
- Center of Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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13
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Killie IL, Braaten T, Lorem GF, Borch KB. Associations Between Self-Rated Health and Mortality in the Norwegian Women and Cancer (NOWAC) Study. Clin Epidemiol 2024; 16:109-120. [PMID: 38404707 PMCID: PMC10893877 DOI: 10.2147/clep.s433965] [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: 08/15/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women. Population and Methods We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41-70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up. Results With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HRgood SRH 1.19, 95% CI 1.12-1.26) and HRpoor SRH 1.81, 95% CI 1.66-1.97). Lower SRH at baseline was associated with cancer incidence (HRgood SRH 1.14, 95% CI 1.08-1.20 and HRpoor SRH 1.44, 95% CI: 1.32-1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HRpoor SRH 1.20, 95% CI 1.04-1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HRgood SRH 1.59, 95% CI 1.44-1.77 and HRpoor SRH 3.34, 95% CI 2.91-3.84). Conclusion Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.
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Affiliation(s)
- Ida Løken Killie
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Geir Fagerjord Lorem
- Department of Psychology, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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14
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Bermas BL, Gerber DE. The Joint Problem of Rheumatoid Arthritis and Lung Cancer. J Thorac Oncol 2024; 19:196-198. [PMID: 38325979 DOI: 10.1016/j.jtho.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Bonnie L Bermas
- Division of Rheumatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David E Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
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15
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LoPiccolo J, Gusev A, Christiani DC, Jänne PA. Lung cancer in patients who have never smoked - an emerging disease. Nat Rev Clin Oncol 2024; 21:121-146. [PMID: 38195910 PMCID: PMC11014425 DOI: 10.1038/s41571-023-00844-0] [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] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Lung cancer is the most common cause of cancer-related deaths globally. Although smoking-related lung cancers continue to account for the majority of diagnoses, smoking rates have been decreasing for several decades. Lung cancer in individuals who have never smoked (LCINS) is estimated to be the fifth most common cause of cancer-related deaths worldwide in 2023, preferentially occurring in women and Asian populations. As smoking rates continue to decline, understanding the aetiology and features of this disease, which necessitate unique diagnostic and treatment paradigms, will be imperative. New data have provided important insights into the molecular and genomic characteristics of LCINS, which are distinct from those of smoking-associated lung cancers and directly affect treatment decisions and outcomes. Herein, we review the emerging data regarding the aetiology and features of LCINS, particularly the genetic and environmental underpinnings of this disease as well as their implications for treatment. In addition, we outline the unique diagnostic and therapeutic paradigms of LCINS and discuss future directions in identifying individuals at high risk of this disease for potential screening efforts.
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Affiliation(s)
- Jaclyn LoPiccolo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- The Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Alexander Gusev
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- The Eli and Edythe L. Broad Institute, Cambridge, MA, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- The Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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16
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [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: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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17
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Zhong Q, An K, Wu Z, Zhang H, Li S, Zhang L, Li C, Li H, Zhuo Ga QM, Yang Zong DJ, An Z. Knowledge and awareness of nicotine, nicotine replacement therapy, and electronic cigarettes among general practitioners with a special interest in respiratory medicine in China. Front Med (Lausanne) 2024; 10:1236453. [PMID: 38264047 PMCID: PMC10805112 DOI: 10.3389/fmed.2023.1236453] [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: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
Objectives This study aimed to assess the knowledge and awareness of nicotine, nicotine replacement therapy (NRT), and electronic cigarettes (e-cigarettes) among general practitioners with a special interest (GPwSIs) in respiratory medicine. Methods A cross-sectional study was conducted from October 2021 to February 2022. Knowledge and awareness were compared among smokers and non-smokers, as well as different age and gender groups. Results The study consisted of 102 GPwSIs from 21 cities in Sichuan Province, China. Most respondents would recommend NRT for long-term use. Only a few believed that e-cigarettes are an effective means of smoking cessation and 71.6% would not recommend e-cigarettes as a substitute for cigarettes to their patients. Additionally, the majority did not regularly provide extensive help to assist patients in quitting smoking and needed smoking cessation counseling training. Conclusion GPwSIs in respiratory medicine in China could have a relatively low level of knowledge and awareness regarding nicotine, NRT, and e-cigarettes. The study highlights the need for smoking cessation training among GPwSIs to improve their knowledge and provide better assistance to patients who want to quit smoking.
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Affiliation(s)
- Qian Zhong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kang An
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, Multimorbidity Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zengxiang Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, Multimorbidity Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haijun Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, Multimorbidity Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shengxi Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, Multimorbidity Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Caizheng Li
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, Multimorbidity Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Heting Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Mei Zhuo Ga
- Department of General Practice, People’s Hospital of Lhasa, Lhasa, Tibet, China
| | - De Ji Yang Zong
- Department of General Practice, People’s Hospital of Lhasa, Lhasa, Tibet, China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Halms T, Strasser M, Hasan A, Rüther T, Trepel M, Raab S, Gertzen M. Smoking and quality of life in lung cancer patients: systematic review. BMJ Support Palliat Care 2024; 13:e686-e694. [PMID: 37607808 DOI: 10.1136/spcare-2023-004256] [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: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC. METHODS A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies. RESULTS A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive. CONCLUSIONS The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Marcus Gertzen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
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19
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Khurshid H, Ismaila N, Bian J, Dabney R, Das M, Ellis P, Feldman J, Hann C, Kulkarni S, Laskin J, Manochakian R, Mishra DR, Preeshagul I, Reddy P, Saxena A, Weinberg F, Kalemkerian GP. Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline. J Clin Oncol 2023; 41:5448-5472. [PMID: 37820295 DOI: 10.1200/jco.23.01435] [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: 07/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | - Peter Ellis
- Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jill Feldman
- EGFR Resisters Patient Advocacy Group, Deerfield, IL
| | | | - Swati Kulkarni
- Western University, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| | - Janessa Laskin
- University of British Columbia, Vancouver, British Columbia, Canada
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20
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Ramesh V, Gollavilli PN, Pinna L, Siddiqui MA, Turtos AM, Napoli F, Antonelli Y, Leal-Egaña A, Havelund JF, Jakobsen ST, Boiteux EL, Volante M, Faergeman NJ, Jensen ON, Siersbaek R, Somyajit K, Ceppi P. Propionate reinforces epithelial identity and reduces aggressiveness of lung carcinoma. EMBO Mol Med 2023; 15:e17836. [PMID: 37766669 DOI: 10.15252/emmm.202317836] [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: 04/11/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The epithelial-to-mesenchymal transition (EMT) plays a central role in the development of cancer metastasis and resistance to chemotherapy. However, its pharmacological treatment remains challenging. Here, we used an EMT-focused integrative functional genomic approach and identified an inverse association between short-chain fatty acids (propionate and butanoate) and EMT in non-small cell lung cancer (NSCLC) patients. Remarkably, treatment with propionate in vitro reinforced the epithelial transcriptional program promoting cell-to-cell contact and cell adhesion, while reducing the aggressive and chemo-resistant EMT phenotype in lung cancer cell lines. Propionate treatment also decreased the metastatic potential and limited lymph node spread in both nude mice and a genetic NSCLC mouse model. Further analysis revealed that chromatin remodeling through H3K27 acetylation (mediated by p300) is the mechanism underlying the shift toward an epithelial state upon propionate treatment. The results suggest that propionate administration has therapeutic potential in reducing NSCLC aggressiveness and warrants further clinical testing.
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Affiliation(s)
- Vignesh Ramesh
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Interdisciplinary Centre for Clinical Research, University Hospital Erlangen, FAU-Erlangen-Nuremberg, Erlangen, Germany
| | - Paradesi Naidu Gollavilli
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Interdisciplinary Centre for Clinical Research, University Hospital Erlangen, FAU-Erlangen-Nuremberg, Erlangen, Germany
| | - Luisa Pinna
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Mohammad Aarif Siddiqui
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Adriana Martinez Turtos
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Francesca Napoli
- Department of Oncology at San Luigi Hospital, University of Turin, Turin, Italy
| | - Yasmin Antonelli
- Institute for Molecular Systems Engineering and Advanced Materials, Heidelberg University, Heidelberg, Germany
| | - Aldo Leal-Egaña
- Institute for Molecular Systems Engineering and Advanced Materials, Heidelberg University, Heidelberg, Germany
| | - Jesper Foged Havelund
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Simon Toftholm Jakobsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Elisa Le Boiteux
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Marco Volante
- Department of Oncology at San Luigi Hospital, University of Turin, Turin, Italy
| | - Nils Joakim Faergeman
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Ole N Jensen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Rasmus Siersbaek
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Kumar Somyajit
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Paolo Ceppi
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Interdisciplinary Centre for Clinical Research, University Hospital Erlangen, FAU-Erlangen-Nuremberg, Erlangen, Germany
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21
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Daama A, Mugamba S, Ddaaki W, Nalwoga GK, Kasango A, Nalugoda F, Bulamba R, Nkale JM, Kyasanku E, Bulamu R, Nakigozi G, Kigozi G, Kagaayi J, Kisaka S. Motivations for continued tobacco smoking and reasons for quitting among youths in Wakiso district, Uganda: a qualitative study. BMC PRIMARY CARE 2023; 24:263. [PMID: 38053058 PMCID: PMC10696750 DOI: 10.1186/s12875-023-02218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Efforts have been invested towards cessation of tobacco use among youths aged 18-35 years, however, motivators for continued tobacco smoking and reasons for quitting are limited in Ugandan settings. Therefore, this study aimed to explore motivations for continued tobacco smoking and reasons for quitting in Wakiso district Uganda. METHODS This study used explanatory sequential method. Data from a Population-based survey collected from October 2019 to September 2020 was used to select participants for this qualitative study. Twenty-three in-depths interviews were conducted from July to October 2021 among youths (18-35years old) who reported continued tobacco use and those who quit. Data were analyzed using a team-based thematic content approach with the help of NVivo. RESULTS Data was collected from a total of twenty three participants, fourteen were tobacco quitters and nine were current tobacco smokers. Recurrent habit, desire to complement the use of other drugs, peer pressure, using smoking as a replacement for alcohol consumption, low tobacco prices, smoking as a tradition were reported as motivators for continued tobacco smoking. However, reported reasons for quitting smoking by youths included; packaging health warnings, school based prevention programs, fear of associated health risks due to tobacco use, embarrassment from family members. CONCLUSION Targeted, and tailored tobacco prevention counselling through family support programs, intensified health education on the risks of smoking, and implementing stronger health warnings on tobacco packaging can be employed to reduce or stop tobacco use among urban youth.
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Affiliation(s)
- Alex Daama
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda.
- Makerere University School of Public Health, Kampala, Uganda.
| | - Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - William Ddaaki
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Grace Kigozi Nalwoga
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Asani Kasango
- Makerere University School of Public Health, Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Robert Bulamba
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - James Menya Nkale
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Emmanuel Kyasanku
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Ritah Bulamu
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization, Plot 7441, Nansana, Hoima Road, P.O Box 25974, Nansana, Uganda
| | - Joseph Kagaayi
- Makerere University School of Public Health, Kampala, Uganda
| | - Stevens Kisaka
- Makerere University School of Public Health, Kampala, Uganda
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Gemine RE, Davies GR, Lanyon K, Rees SE, Campbell I, Lewis KE. Quitting smoking improves two-year survival after a diagnosis of non-small cell lung cancer. Lung Cancer 2023; 186:107388. [PMID: 37820539 DOI: 10.1016/j.lungcan.2023.107388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Smoking at diagnosis is associated with worse survival in lung cancer but the effects of quitting smoking on survival remain unclear. METHODS In a UK multi-centre study (NCT01192256) we followed all 2751 patients with newly diagnosed non-small cell lung cancer (NSCLC) for up to 2 years or until death as part of the observational trial. Patients were offered smoking cessation advice and treatments according to national guidelines and local services. Smoking status was verified by exhaled carbon monoxide levels. Kaplan-Meier survival analysis and Cox Proportional Hazards Modelling examined the effects of quitting smoking on survival at 2 years. FINDINGS 646 were current smokers at the time of diagnosis. The unadjusted two-year Kaplan-Meier survivor functions for quitters (0.45, 95 %CI 0.37 to 0.53) and continuers (0.32, 0.28 to 0.36) were significantly different (log-rank test p < 0.01). Median survival times were 659 days for quitters and 348 days for continuers. After adjusting for age, sex, stage, performance status, curative intent surgery, radical radiotherapy and comorbidity, the hazard ratio for quitting at diagnosis (0.75, 95 % CI 0.58 to 0.98) indicated a statistically significant reduction in the risk of death across the two-year study period. INTERPRETATION Quitting smoking is independently and significantly associated with improved survival regardless of stage in NSCLC. We recommend that smoking cessation advice and treatments should be offered to smokers with lung cancer. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01192256. FUNDING This work was supported by a 2010 Global Research Award for Nicotine Dependence (GRAND), Pfizer.
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Affiliation(s)
- Rachel E Gemine
- Department of Research & Development, Innovation & Value Based Health, Hywel Dda University Health Board, Prince Philip Hospital, Llanelli, Wales; Research & Innovation, Digital Health and Care Wales, Cardiff, Wales; School of Medicine, Faculty Health Sciences, Swansea University, Singleton Park, Swansea, Wales.
| | | | - Kirsty Lanyon
- School of Medicine, Faculty Health Sciences, Swansea University, Singleton Park, Swansea, Wales
| | - Sarah E Rees
- Department of Research & Development, Innovation & Value Based Health, Hywel Dda University Health Board, Prince Philip Hospital, Llanelli, Wales
| | - Ian Campbell
- Honorary Consultant Physician, Cardiff & Vale University Health Board, Llandough Hospital, Penarth, Cardiff, Wales
| | - Keir E Lewis
- School of Medicine, Faculty Health Sciences, Swansea University, Singleton Park, Swansea, Wales; Department of Respiratory Medicine, Hywel Dda University Health Board, Prince Philip Hospital, Llanelli, Wales; Respiratory Innovation Wales, Llanelli, Wales
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23
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Mander ES, Merrick CB, Nicholson HA, Lord HK, Ferguson MJ, Smith G. Pembrolizumab monotherapy for non-small cell lung cancer (NSCLC): can patient stratification be improved in the UK Tayside population? A retrospective cohort study. BMJ Open 2023; 13:e076715. [PMID: 37989364 PMCID: PMC10668179 DOI: 10.1136/bmjopen-2023-076715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Pembrolizumab is a programmed cell death protein-1 (PD-1) inhibitor used to treat advanced patients with non-small cell lung cancer (NSCLC) with a programmed cell death ligand-1 (PD-L1) tumour proportion score (TPS) ≥50. Further sub-division of TPS-based stratification has not been evaluated in the UK, although smoking-induced tumour mutational burden and the immunogenic effects of prior radiotherapy are suggested to improve response. AIMS To investigate if PD-L1 TPS ≥80%, smoking status or radiotherapy before or within 2 months of treatment influenced progression-free survival (PFS) in patients with NSCLC treated with pembrolizumab monotherapy. METHODS PD-L1 TPS, smoking status and radiotherapy exposure were compared in patients with NSCLC in National Health Service (NHS) Tayside (n=100) treated with pembrolizumab monotherapy between 1 November 2017 and 18 February 2022. Survival estimates were compared using log-rank analysis, and Cox proportional hazards analysis was used to investigate the influence of potential confounding factors, including tumour stage and performance status. RESULTS PFS was not significantly different (log-rank HR=0.330, p=0.566) comparing patients with PD-L1 TPS 50-79% and PD-L1 TPS ≥80%. Smokers had significantly improved PFS (log-rank HR=4.867, p=0.027), while patients receiving radiotherapy had significantly decreased PFS (log-rank HR=6.649, p=0.012). A Cox regression model confirmed that both radiotherapy (p=0.022) and performance status (p=0.009) were independent negative predictors of PFS. CONCLUSIONS More rigorous PD-L1 TPS stratification did not influence survival outcomes. Smoking history improved PFS, although it was not an independent response predictor, while radiotherapy and performance status independently influenced clinical response. We suggest that further stratification of PD-L1 TPS is not warranted, while performance status and radiotherapy treatment may be additional clinically useful biomarkers of response to pembrolizumab in patients with NSCLC.
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Affiliation(s)
| | | | | | | | | | - Gillian Smith
- School of Medicine, University of Dundee, Dundee, UK
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24
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Lu Q, Tang Y, Luo S, Gong Q, Li C. Coptisine, the Characteristic Constituent from Coptis chinensis, Exhibits Significant Therapeutic Potential in Treating Cancers, Metabolic and Inflammatory Diseases. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2023; 51:2121-2156. [PMID: 37930333 DOI: 10.1142/s0192415x2350091x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Naturally derived alkaloids belong to a class of quite significant organic compounds. Coptisine, a benzyl tetrahydroisoquinoline alkaloid, is one of the major bioactive constituents in Coptis chinensis Franch., which is a famous traditional Chinese medicine. C. chinensis possesses many kinds of functions, including the ability to eliminate heat, expel dampness, purge fire, and remove noxious substances. In Asian countries, C. chinensis is traditionally employed to treat carbuncle and furuncle, diabetes, jaundice, stomach and intestinal disorders, red eyes, toothache, and skin disorders. Up to now, there has been plenty of research of coptisine with respect to its pharmacology. Nevertheless, a comprehensive review of coptisine-associated research is urgently needed. This paper was designed to summarize in detail the progress in the research of the pharmacology, pharmacokinetics, safety, and formulation of coptisine. The related studies included in this paper were retrieved from the following academic databases: The Web of Science, PubMed, Google scholar, Elsevier, and CNKI. The cutoff date was January 2023. Coptisine manifests various pharmacological actions, including anticancer, antimetabolic disease, anti-inflammatory disease, and antigastrointestinal disease effects, among others. Based on its pharmacokinetics, the primary metabolic site of coptisine is the liver. Coptisine is poorly absorbed in the gastrointestinal system, and most of it is expelled in the form of its prototype through feces. Regarding safety, coptisine displayed potential hepatotoxicity. Some novel formulations, including the [Formula: see text]-cyclodextrin-based inclusion complex and nanocarriers, could effectively enhance the bioavailability of coptisine. The traditional use of C. chinensis is closely connected with the pharmacological actions of coptisine. Although there are some disadvantages, including poor solubility, low bioavailability, and possible hepatotoxicity, coptisine is still a prospective naturally derived drug candidate, especially in the treatment of tumors as well as metabolic and inflammatory diseases. Further investigation of coptisine is necessary to facilitate the application of coptisine-based drugs in clinical practice.
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Affiliation(s)
- Qiang Lu
- Department of Pharmaceutical Sciences, Zhuhai Campus, Zhuhai 519041, P. R. China
| | - Ying Tang
- Department of Pharmacology, Zunyi Medical University, Zhuhai Campus, Zhuhai 519041, P. R. China
| | - Shuang Luo
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518005, P. R. China
| | - Qihai Gong
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, P. R. China
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi 563000, P. R. China
| | - Cailan Li
- Department of Pharmacology, Zunyi Medical University, Zhuhai Campus, Zhuhai 519041, P. R. China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, P. R. China
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi 563000, P. R. China
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25
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Wharram CE, Kyko JM, Ruterbusch JJ, Beebe-Dimmer JL, Schwartz AG, Cote ML. Use of electronic cigarettes among African American cancer survivors. Cancer 2023; 129:3334-3345. [PMID: 37395113 DOI: 10.1002/cncr.34933] [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: 01/12/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) is increasing rapidly in the United States, although the negative health outcomes associated with these products are still unknown. Emerging research has examined the use of e-cigarettes in the cancer survivor population as a whole, yet none has focused on e-cigarette use in the African American (AA) cancer survivor population. METHODS The authors used data from the Detroit Research on Cancer Survivors cohort study, comprised of AA adult cancer survivors. Logistic regression models were used to evaluate factors potentially associated with e-cigarette ever use and current use. RESULTS Of 4443 cancer survivors who completed a baseline interview, 8.3% (n = 370) reported ever using e-cigarettes, and 16.5% (n = 61) of those reporting ever use also reported current use of e-cigarettes. Ever users and current users were on average younger than those who did not use e-cigarettes (57.5 vs. 61.2 years; p < .001). Current cigarette smokers were >20 times more likely (odds ratio, 20.75; 95% confidence interval, 12.84-33.55) and former smokers were almost 10 times more likely (odds ratio, 9.50; 95% confidence interval, 6.03-14.97) to have ever used e-cigarettes than never-smokers. Preliminary data suggested that ever use of e-cigarettes is associated with later stage at diagnosis for breast and colorectal cancers. CONCLUSIONS As the use of e-cigarettes increases in the general population, it is important to continue to monitor their use in cancer survivors and to gain more insight as it pertains to the AA cancer survivor population. Elucidation of the factors associated with e-cigarette use in this population may help inform comprehensive cancer survivorship recommendations and interventions.
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Affiliation(s)
| | - Jaclyn M Kyko
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
| | | | - Jennifer L Beebe-Dimmer
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Ann G Schwartz
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michele L Cote
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
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26
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Evans WK, Tammemägi MC, Walker MJ, Cameron E, Leung YW, Ashton S, de Loë J, Doyle W, Bornais C, Allie E, Alkema K, Bravo CA, McGarry C, Rey M, Truscott R, Darling G, Rabeneck L. Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot. J Thorac Oncol 2023; 18:1323-1333. [PMID: 37422265 DOI: 10.1016/j.jtho.2023.07.004] [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: 11/12/2022] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Low-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC). METHODS The impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked. RESULTS A total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%-17.7%; range: 10.5%-20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program. CONCLUSIONS On the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.
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Affiliation(s)
- William K Evans
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
| | - Martin C Tammemägi
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Meghan J Walker
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erin Cameron
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yvonne W Leung
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; College of Professional Studies, Northeastern University-Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sara Ashton
- Administration, Lakeridge Health, Oshawa, Ontario, Canada
| | - Julie de Loë
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wanda Doyle
- Health Promotion Screening Program, Champlain Regional Cancer Program, Ottawa, Ontario, Canada
| | - Chantal Bornais
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ellen Allie
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Koop Alkema
- Cancer Screening Program, Northeast Cancer Centre - Health Sciences North, Sudbury, Ontario, Canada
| | - Caroline A Bravo
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Caitlin McGarry
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michelle Rey
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Rebecca Truscott
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Linda Rabeneck
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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27
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Tay YL, Ong WS, Liew SZH, Chowdhury AR, Chan J, Ramalingam MB, Rajasekaran T, Tan TJ, Krishna L, Lai O, Chow ALY, Chen S, Kanesvaran R. External validation of the first prognostic nomogram for older adults with cancer. Ther Adv Med Oncol 2023; 15:17588359231198433. [PMID: 37786539 PMCID: PMC10541742 DOI: 10.1177/17588359231198433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023] Open
Abstract
Background The geriatric oncology population tends to be complex because of multimorbidity, functional and cognitive decline, malnutrition and social frailty. Prognostic indices for predicting survival of elderly cancer patients to guide treatment remain scarce. A nomogram based on all domains of the geriatric assessment was previously developed at the National Cancer Centre Singapore (NCCS) to predict overall survival (OS) in elderly cancer patients. This nomogram comprised of six variables (age, eastern cooperative oncology group performance status, disease stage, geriatric depression scale (GDS), DETERMINE nutritional index and serum albumin). Objectives To externally validate the NCCS prognostic nomogram. Design This is a prospective cohort study. Methods The nomogram was developed based on a training cohort of 249 patients aged ⩾70 years who attended the NCCS outpatient geriatric oncology clinic between May 2007 and November 2010. External validation of the nomogram using the Royston and Altman approach was carried out on an independent testing cohort of 252 patients from the same clinic between July 2015 and June 2017. Model misspecification, discrimination and calibration were assessed. Results Median OS of the testing cohort was 3.1 years, which was significantly higher than the corresponding 1.0 year for the training cohort (log-rank p < 0.001). The nomogram achieved a high level of discrimination in the testing cohort (0.7112), comparable to the training cohort (0.7108). Predicted death probabilities were generally well calibrated with the observed death probabilities, as the joint test of calibration-in-the-large estimates at year 1, 2 and 3 from zeros and calibration slope from one was insignificant with p = 0.432. There were model misspecifications in GDS and serum albumin. Conclusion This study externally validated the prognostic nomogram in an independent cohort of geriatric oncology patients. This supports the use of this nomogram in clinical practice.
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Affiliation(s)
- Yu Ling Tay
- Department of Geriatric Medicine, Singapore General Hospital, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | | | | | - Johan Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Tira J. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Lalit Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Olive Lai
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Agnes Lai Yin Chow
- Division of Medical Oncology – Research, National Cancer Centre Singapore, Singapore
| | - Simon Chen
- Department of Nursing, National Cancer Centre Singapore, Singapore
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
- Oncology ACP, Singhealth Duke-NUS, Singapore
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28
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Murray RL, O'Dowd E. Smoking cessation and lung cancer: never too late to quit. Lancet Public Health 2023; 8:e664-e665. [PMID: 37633673 DOI: 10.1016/s2468-2667(23)00158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Rachael L Murray
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
| | - Emma O'Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
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29
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Fares AF, Li Y, Jiang M, Brown MC, Lam ACL, Aggarwal R, Schmid S, Leighl NB, Shepherd FA, Wang Z, Diao N, Wenzlaff AS, Xie J, Kohno T, Caporaso NE, Harris C, Ma H, Barnett MJ, Leal LF, Fernandez-Tardon G, Pérez-Ríos M, Davies MPA, Taylor F, Schöttker B, Brennan P, Zaridze D, Holcatova I, Lissowska J, Świątkowska B, Mates D, Savic M, Brenner H, Andrew A, Cox A, Field JK, Ruano-Ravina A, Shete SS, Tardon A, Wang Y, Le Marchand L, Reis RM, Schabath MB, Chen C, Shen H, Ryan BM, Landi MT, Shiraishi K, Zhang J, Schwartz AG, Tsao MS, Christiani DC, Yang P, Hung RJ, Xu W, Liu G. Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival: a retrospective, pooled analysis of cohort studies. Lancet Public Health 2023; 8:e691-e700. [PMID: 37633678 PMCID: PMC10540150 DOI: 10.1016/s2468-2667(23)00131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. METHODS In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. FINDINGS Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions. INTERPRETATION In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. FUNDING The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.
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Affiliation(s)
- Aline F Fares
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Division of Medical Oncology, Faculty of Medicine of São José do Rio Preto, São Paulo, Brazil
| | - Yao Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mei Jiang
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Catherine Brown
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew C L Lam
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Reenika Aggarwal
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sabine Schmid
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Universitätsklinik für Medizinische Onkologie, Inselspital Bern, Bern, Switzerland
| | - Natasha B Leighl
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zhichao Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Nancy Diao
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Angela S Wenzlaff
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Neil E Caporaso
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Curtis Harris
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Matthew J Barnett
- Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Leticia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - G Fernandez-Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Michael P A Davies
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Fiona Taylor
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Weston Park Cancer Centre, Sheffield Teaching Hospital Foundation Trust, Sheffield, UK
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network of Aging Research, Heidelberg University, Heidelberg, Germany
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - David Zaridze
- N N Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Ivana Holcatova
- Institute of Public Health and Preventive Medicine and Department of Oncology, Second Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Milan Savic
- Department of Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany; National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | - Angela Cox
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sanjay S Shete
- M D Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Adonina Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Ying Wang
- American Cancer Society, Atlanta, GA, USA
| | - Loic Le Marchand
- University of Hawai'i Cancer Centre, University of Hawai'i, Honolulu, HI, USA
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil; Life and Health Sciences Research Institute, Medical School, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute-Biomaterials, Biodegradables and Biomimetics Research Group Associate Laboratory, Braga, Portugal
| | | | - Chu Chen
- Program in Epidemiology, Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Brid M Ryan
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Maria Teresa Landi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan; Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Ming S Tsao
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - David C Christiani
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rayjean J Hung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Koru-Sengul T, Pinheiro PS, Zhao W, Hernandez MN, Hernandez DR, Maggioni A, Kobetz EN, Caban-Martinez AJ, Lee DJ. Lung cancer survival among Florida male firefighters. Front Oncol 2023; 13:1155650. [PMID: 37664012 PMCID: PMC10473410 DOI: 10.3389/fonc.2023.1155650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Lung cancer is a leading cause of cancer incidence and death in the United States. Although most firefighters are fit and do not smoke, they are exposed to many known carcinogens during and in the aftermath of firefighting activities. Comprehensive epidemiologic investigations on lung cancer survival for both career and volunteer firefighters have not been undertaken. Methods Data from the Florida Cancer Data System (1981-2014) were linked with firefighter certification records from the Florida State Fire Marshal's Office to identify all patients of this occupational group; lung cancer cause-specific survival data were compared with other occupational groups using Cox regression models with occupation as the main effect. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. Results Out of 210,541 male lung cancer cases diagnosed in Florida (1981-2014), 761 were firefighters (604 career, 157 volunteer). Lung cancer death was similar between volunteer (75.2%) and career firefighters (74.0%) but lower than non-firefighters (80.0%). Survival at 5 years was higher among firefighters (29.7%; career: 30.3%; volunteer: 27.4%) than non-firefighters (23.8%). In a multivariable model, compared with non-firefighters, firefighters have significantly higher cause-specific survival (aHR = 0.84; 95% CI: 0.77-0.91; p < 0.001). However, there were no significant survival differences between career and volunteer firefighters (1.14; 0.93-1.39; p = 0.213). In a separate multivariable model with firefighters as the comparator, other broad occupational groups had significantly lower cause-specific survival [white collar: 1.11 (1.02-1.21); blue collar: 1.15 (1.05-1.25); service: 1.13 (1.03-1.25); others/unknown: 1.21 (1.12-1.32); all p-values < 0.02]. Conclusion Lung cancer survival is significantly higher among firefighters compared with non-firefighters, but there is no significant difference between career and volunteer firefighters. Improved survival for firefighters might be due to a healthy worker effect, lower smoking prevalence relative to other worker groups, and possibly superior treatment adherence and compliance. Many firefighters are cross-trained as EMTs/paramedics and possess a level of medical knowledge that may favorably impact treatment engagement and better navigation of complex cancer care.
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Affiliation(s)
- Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Monique N. Hernandez
- Florida Cancer Data System, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Diana R. Hernandez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Alessandra Maggioni
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Erin N. Kobetz
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Physical Medicine and Rehabilitation, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - David J. Lee
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Florida Cancer Data System, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
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Zhou A, Zhang D, Kang X, Brooks JD. Identification of age- and immune-related gene signatures for clinical outcome prediction in lung adenocarcinoma. Cancer Med 2023; 12:17475-17490. [PMID: 37434467 PMCID: PMC10501266 DOI: 10.1002/cam4.6330] [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: 03/23/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The understanding of the factors causing decreased overall survival (OS) in older patients compared to younger patients in lung adenocarcinoma (LUAD) remains. METHODS Gene expression profiles of LUAD were obtained from publicly available databases by Kaplan-Meier analysis was performed to determine whether age was associated with patient OS. The immune cell composition in the tumor microenvironment (TME) was evaluated using CIBERSORT. The fraction of stromal and immune cells in tumor samples were also using assessed using multiple tools including ESTIMATE, EPIC, and TIMER. Differentially expressed genes (DEGs) from the RNA-Seq data that were associated with age and immune cell composition were identified using the R package DEGseq. A 22-gene signature composed of DEGs associated with age and immune cell composition that predicted OS were constructed using Least Absolute Shrinkage and Selection Operator (LASSO). RESULTS In The Cancer Genome Atlas (TCGA)-LUAD dataset, we found that younger patients (≤70) had a significant better OS compared to older patients (>70). In addition, older patients had significantly higher expression of immune checkpoint proteins including inhibitory T cell receptors and their ligands. Moreover, analyses using multiple bioinformatics tools showed increased immune infiltration, including CD4+ T cells, in older patients compared to younger patients. We identified a panel of genes differentially expressed between patients >70 years compared to those ≤70 years, as well as between patients with high or low immune scores and selected 84 common genes to construct a prognostic gene signature. A risk score calculated based on 22 genes selected by LASSO predicted 1, 3, and 5-year OS, with an area under the curve (AUC) of 0.72, 0.72, 0.69, receptively, in TCGA-LUAD dataset and an independent validation dataset available from the European Genome-phenome Archive (EGA). CONCLUSION Our results demonstrate that age contributes to OS of LUAD patients atleast in part through its association with immune infiltration in the TME.
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Affiliation(s)
- Andrew Zhou
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Dalin Zhang
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Xiaoman Kang
- Department of OncologyStanford University School of MedicineStanfordCaliforniaUSA
| | - James D. Brooks
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
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Ding K, Jiang X, Ni J, Zhang C, Li A, Zhou J. JWA inhibits nicotine-induced lung cancer stemness and progression through CHRNA5/AKT-mediated JWA/SP1/CD44 axis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:115043. [PMID: 37224781 DOI: 10.1016/j.ecoenv.2023.115043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
Cigarette smoking is an independent risk factor for lung cancer. Nicotine, as an addictive substance in tobacco and e-cigarettes, is known to promote tumor progression and metastasis despite being a non-carcinogen. As a tumor suppressor gene, JWA is widely involved in the inhibition of tumor growth and metastasis and the maintenance of cellular homeostasis, including in non-small cell lung cancer (NSCLC). However, the role of JWA in nicotine-induced tumor progression remains unclear. Here, we reported for the first time that JWA was significantly downregulated in smoking-related lung cancer and associated with overall survival. Nicotine exposure reduced JWA expression in a dose-dependent manner. Gene Set Enrichment Analysis (GSEA) analysis showed the tumor stemness pathway was enriched in smoking-related lung cancer, and JWA was negatively associated with stemness molecules CD44, SOX2, and CD133. JWA also inhibited nicotine-enhanced colony formation, spheroid formation, and EDU incorporation in lung cancer cells. Mechanically, nicotine downregulated JWA expression via the CHRNA5-mediated AKT pathway. Lower JWA expression enhanced CD44 expression through inhibition of ubiquitination-mediated degradation of Specificity Protein 1 (SP1). The in vivo data indicated that JAC4 through the JWA/SP1/CD44 axis inhibited nicotine-triggered lung cancer progression and stemness. In conclusion, JWA via down-regulating CD44 inhibited nicotine-triggered lung cancer cell stemness and progression. Our study may provide new insights to develop JAC4 for the therapy of nicotine-related cancers.
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Affiliation(s)
- Kun Ding
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Xuqian Jiang
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Jie Ni
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Chao Zhang
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Aiping Li
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China
| | - Jianwei Zhou
- Department of Molecular Cell Biology & Toxicology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China.
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Cani M, Turco F, Butticè S, Vogl UM, Buttigliero C, Novello S, Capelletto E. How Does Environmental and Occupational Exposure Contribute to Carcinogenesis in Genitourinary and Lung Cancers? Cancers (Basel) 2023; 15:2836. [PMID: 37345174 PMCID: PMC10216822 DOI: 10.3390/cancers15102836] [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: 03/26/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Environmental and occupational exposures have been associated with an increased risk of different types of cancers, although the exact mechanisms of higher carcinogenesis risk are not always well understood. Lung cancer is the leading cause of global cancer mortality, and, also, genitourinary neoplasms are among the main causes of cancer-related deaths in Western countries. The purpose of this review is to describe the main environmental and occupational factors that increase the risk of developing lung and genitourinary cancers and to investigate carcinogenesis mechanisms that link these agents to cancer onset. Further objectives are to identify methods for the prevention or the early detection of carcinogenic agents and, therefore, to reduce the risk of developing these cancers or to detect them at earlier stages.
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Affiliation(s)
- Massimiliano Cani
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Fabio Turco
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
| | - Simona Butticè
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
| | - Consuelo Buttigliero
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Silvia Novello
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Enrica Capelletto
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
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Stone E, Myers R. Advances in lung cancer: a ground-breaking decade. THE LANCET. RESPIRATORY MEDICINE 2023; 11:407-409. [PMID: 37147028 DOI: 10.1016/s2213-2600(23)00133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, University of New South Wales, Sydney, NSW 2010, Australia.
| | - Renelle Myers
- University of British Columbia, Vancouver, BC, Canada
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Wang X, Romero-Gutierrez CW, Kothari J, Shafer A, Li Y, Christiani DC. Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non-Small Cell Lung Cancer. JAMA Netw Open 2023; 6:e2311966. [PMID: 37145597 PMCID: PMC10163381 DOI: 10.1001/jamanetworkopen.2023.11966] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Importance Lung cancer remains the leading cause of cancer-related death globally; non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases, and cigarette smoking is the factor most significantly associated with its risk. However, little is known about the association of years since prediagnosis smoking cessation and cumulative smoking with overall survival (OS) following a lung cancer diagnosis. Objective To characterize the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with OS in patients with NSCLC in a lung cancer survivor cohort. Design, Setting, and Participants The cohort study involved patients with NSCLC who were recruited to the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital (Boston, Massachusetts) between 1992 and 2022. Patients' smoking history and baseline clinicopathological characteristics were prospectively collected through questionnaires, and OS following lung cancer diagnosis was regularly updated. Exposures Duration of smoking cessation before a lung cancer diagnosis. Main Outcomes and Measures The primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis. Results Of 5594 patients with NSCLC (mean [SD] age, 65.6 [10.8] years; 2987 men [53.4%]), 795 (14.2%) were never smokers, 3308 (59.1%) were former smokers, and 1491 (26.7%) were current smokers. Cox regression analysis suggested that former smokers had 26% higher mortality (hazard ratio [HR], 1.26; 95% CI, 1.13-1.40; P < .001) and current smokers had 68% higher mortality (HR, 1.68; 95% CI, 1.50-1.89; P < .001) compared with never smokers. Log2-transformed years since smoking cessation before diagnosis were associated with significantly lower mortality among ever smokers (HR, 0.96; 95% CI, 0.93-0.99; P = .003). Subgroup analysis, stratified by clinical stage at diagnosis, revealed that former and current smokers had even shorter OS among patients with early-stage disease. Conclusions and Relevance In this cohort study of patients with NSCLC, quitting smoking early was associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with OS may have varied depending on clinical stage at diagnosis, potentially owing to the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. Detailed smoking history collection should be incorporated into future epidemiological and clinical studies to improve lung cancer prognosis and treatment selection.
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Affiliation(s)
- Xinan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Christopher W Romero-Gutierrez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jui Kothari
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Andrea Shafer
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yi Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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From the IASLC Tobacco Control Committee. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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The clinical impact of continued smoking in patients with breast and other hormone-dependent cancer: A systematic literature review. Crit Rev Oncol Hematol 2023; 184:103951. [PMID: 36805551 DOI: 10.1016/j.critrevonc.2023.103951] [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: 09/16/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
We conducted a systematic review of studies that investigated whether quitting smoking at or around diagnosis improves survival of patients with hormone-dependent cancers (HDC). Nine studies published in 2013-2022 were included. Studies were very diverse in terms of design, definition of quitters and continued smokers, and prevalence of prognostic factors other than smoking cessation (e.g. patients' demographics, tumour characteristic, and treatments). For breast, ovarian, and endometrial cancer, all included studies found that quitters had better overall, disease specific, and disease-free survival than continued smokers. For prostate cancer, there was no evidence of an association of smoking cessation with improved survival. This literature review provided suggestive evidence that female smokers diagnosed with cancer of the breast, ovary, or endometrium may improve their chances of surviving by stopping smoking. Smoking cessation counselling should become part of standard oncological care for these patients and integrated into breast cancer screening programs.
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Presant CA, Ashing K, Raz D, Yeung S, Gascon B, Stewart A, Macalintal J, Sandoval A, Ehrunmwunsee L, Phillips T, Salgia R, Merla A, Subbiah S, El-Hajjouie M, Staley J, Graves H, Pathak R, Dingal S, Sampath S, Laksana B, Joseph T, Eugenio T, Degoma V, Burns K, Phillips S, Tan T, Tarkshian K, Sun V, Amini A, Davy K, Cronkhite J, Cianfrocca M, Brown S, Fong Y, Rosen S. Overcoming Barriers to Tobacco Cessation and Lung Cancer Screening among Racial and Ethnic Minority Groups and Underserved Patients in Academic Centers and Community Network Sites: The City of Hope Experience. J Clin Med 2023; 12:1275. [PMID: 36835811 PMCID: PMC9965998 DOI: 10.3390/jcm12041275] [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: 12/21/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Tobacco control is important for cancer patient health, but delivering effective low-dose CT (LDCT) screening and tobacco cessation is more difficult in underserved and patients from racial and ethnic minority groups. At City of Hope (COH), we have developed strategies to overcome barriers to the delivery of LDCT and tobacco cessation. METHODS We performed a needs assessment. New tobacco control program services were implemented focusing on patients from racial and ethnic minority groups. Innovations included Whole Person Care with motivational counseling, placing clinician and nurse champions at points of care, training module and leadership newsletters, and a patient-centric personalized medicine Personalized Pathways to Success (PPS) program. RESULTS Emphasis on patients from racial and ethnic minority groups was implemented by training cessation personnel and lung cancer control champions. LDCT increased. Tobacco use assessment increased and abstinence was 27.2%. The PPS pilot program achieved 47% engagement in cessation, with self-reported abstinence at 3 months of 38%, with both results slightly higher in patients from racial and ethnic minority groups than in Caucasian patients. CONCLUSIONS Tobacco cessation barrier-focused innovations can result in increased lung cancer screening and tobacco cessation reach and effectiveness, especially among patients from racial and ethnic minority groups. The PPS program is promising as a personalized medicine patient-centric approach to cessation and lung cancer screening.
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Affiliation(s)
- Cary A. Presant
- City of Hope Medical Center, 1500 East Duarte Rd, Duarte, CA 91010, USA
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Caini S, Del Riccio M, Gandini S. Response to the Comment by Yang X et al. J Thorac Oncol 2023; 18:e19-e21. [PMID: 36682845 DOI: 10.1016/j.jtho.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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40
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Zhang L, Yang X. Comment on: "Quitting Smoking at or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis". J Thorac Oncol 2023; 18:e17-e19. [PMID: 36682844 DOI: 10.1016/j.jtho.2022.09.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Lei Zhang
- The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xueying Yang
- The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.
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Preda M, Tănase BC, Zob DL, Gheorghe AS, Lungulescu CV, Dumitrescu EA, Stănculeanu DL, Manolescu LSC, Popescu O, Ibraim E, Mahler B. The Bidirectional Relationship between Pulmonary Tuberculosis and Lung Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1282. [PMID: 36674038 PMCID: PMC9859200 DOI: 10.3390/ijerph20021282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Lung cancer and pulmonary tuberculosis are two significant public health problems that continue to take millions of lives each year. They may have similar symptoms and, in some cases, are diagnosed simultaneously or may have a causal relationship. In tuberculosis disease, the chronic inflammation, different produced molecules, genomic changes, and fibrosis are believed to be important factors that may promote carcinogenesis. As a reverse reaction, the development of carcinogenesis and the treatment may induce the reactivation of latent tuberculosis infection. Moreover, the recently used checkpoint inhibitors are a debatable subject since they help treat lung cancer but may lead to the reactivation of pulmonary tuberculosis and checkpoint-induced pneumonitis. Pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and lung cancer patients and should be recommended to improve outcomes in these pathologies.
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Affiliation(s)
- Mădălina Preda
- Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania
- Microbiology, Parasitology and Virology Discipline, Department of Fundamental Sciences, Faculty of Midwives and Nursing, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Cosmin Tănase
- Department of Thoracic Surgery, Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest, 022328 Bucharest, Romania
| | - Daniela Luminița Zob
- Department of Medical Oncology II, Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest, 022328 Bucharest, Romania
| | - Adelina Silvana Gheorghe
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology I, Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest, 022328 Bucharest, Romania
| | | | - Elena Adriana Dumitrescu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dana Lucia Stănculeanu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology I, Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest, 022328 Bucharest, Romania
| | - Loredana Sabina Cornelia Manolescu
- Microbiology, Parasitology and Virology Discipline, Department of Fundamental Sciences, Faculty of Midwives and Nursing, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Virology, Institute of Virology “Stefan S. Nicolau”, 030304 Bucharest, Romania
| | - Oana Popescu
- Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania
| | - Elmira Ibraim
- Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania
| | - Beatrice Mahler
- Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania
- Pneumo-Phthisiology II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Wu H, Yang J, Wang H, Li L. Mendelian randomization to explore the direct or mediating associations between socioeconomic status and lung cancer. Front Oncol 2023; 13:1143059. [PMID: 37207156 PMCID: PMC10189779 DOI: 10.3389/fonc.2023.1143059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
Objective The purpose of this study was to verify whether there are direct or mediated causal associations between socioeconomic status and lung cancer. Methods Pooled statistics were obtained from corresponding genome-wide association studies. The inverse-variance weighted, weighted median, MR-Egger, MR-PRESSO and contamination-mixture methods were used as supplements to Mendelian randomization (MR) statistical analysis. Cochrane's Q value and the MR-Egger intercept were used for sensitivity analysis. Results In the univariate MR analysis, household income and education had protective effects on overall lung cancer (income: P = 5.46×10-4; education: P = 4.79×10-7) and squamous cell lung cancer (income: P = 2.67×10-3; education: P = 1.42×10-10). Smoking and BMI had adverse effects on overall lung cancer (smoking: P = 2.10×10-7; BMI: P = 5.67×10-4) and squamous cell lung cancer (smoking: P = 5.02×10-6; BMI: P = 2.03×10-7). Multivariate MR analysis found that smoking and education were independent risk factors for overall lung cancer (smoking: P = 1.96×10-7; education: P = 3.11×10-3), while smoking was an independent risk factor for squamous cell lung cancer (P = 2.35×10-6). Smoking, education, and household income mediate the effect of BMI on overall lung cancer (smoking 50.0%, education 49.2%, income 25.3%) and squamous cell lung cancer (smoking 34.8%, education 30.8%, income 21.2%). Smoking, education, and BMI mediate the effect of income on overall lung cancer (smoking 13.9%, education 54.8%, BMI 9.4%) and squamous cell lung cancer (smoking 12.6%, education 63.3%, BMI 11.6%). Smoking, BMI, and income mediate the effect of education on squamous cell lung cancer (smoking 24.0%, BMI 6.2%, income 19.4%). Conclusion Income, education, BMI, and smoking are causally associated with both overall lung cancer and squamous cell lung cancer. Smoking and education are independent association factors for overall lung cancer, while smoking is an independent association factor for squamous cell lung cancer. Smoking and education also play important mediating roles in overall lung cancer and squamous cell lung cancer. No causal relationship was found between multiple risk factors associated with socioeconomic status and lung adenocarcinoma.
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Affiliation(s)
- Hong Wu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jing Yang
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hui Wang
- Department of Orthopaedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lei Li
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China
- *Correspondence: Lei Li,
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Woodford K, Koo K, Reynolds J, Stirling RG, Harden SV, Brand M, Senthi S. Persisting Gaps in Optimal Care of Stage III Non-small Cell Lung Cancer: An Australian Patterns of Care Analysis. Oncologist 2022; 28:e92-e102. [PMID: 36541690 PMCID: PMC9907057 DOI: 10.1093/oncolo/oyac246] [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: 10/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Wide variation exists globally in the treatment and outcomes of stage III patients with non-small cell lung cancer (NSCLC). We conducted an up-to-date patterns of care analysis in the state of Victoria, Australia, with a particular focus on the proportion of patients receiving treatment with radical intent, treatment trends over time, and survival. MATERIALS AND METHODS Stage III patients with NSCLC were identified in the Victorian Lung Cancer Registry and categorized by treatment received and treatment intent. Logistic regression was used to explore factors predictive of receipt of radical treatment and the treatment trends over time. Cox regression was used to explore variables associated with overall survival (OS). Covariates evaluated included age, sex, ECOG performance status, smoking status, year of diagnosis, Australian born, Aboriginal or Torres Strait Islander status, socioeconomic status, rurality, public/private status of notifying institution, and multidisciplinary meeting discussion. RESULTS A total of 1396 patients were diagnosed between 2012 and 2019 and received treatment with radical intent 67%, palliative intent 23%, unknown intent 5% and no treatment 5%. Radical intent treatment was less likely if patients were >75 years, ECOG ≥1, had T3-4 or N3 disease or resided rurally. Surgery use decreased over time, while concurrent chemoradiotherapy and immunotherapy use increased. Median OS was 38.0, 11.1, and 4.4 months following radical treatment, palliative treatment or no treatment, respectively. CONCLUSION Almost a third of stage III patients with NSCLC still do not receive radical treatment. Strategies to facilitate radical treatment and better support decision making between increasing multimodality options are required.
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Affiliation(s)
- Katrina Woodford
- Corresponding author: Katrina Woodford, PhD, Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia. Tel: +61 3 8559 6067; Fax: +61 3 85596009; E-mail:
| | - Kendrick Koo
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC, Australia,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - John Reynolds
- Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Robert G Stirling
- Department of Medicine, Monash University, Clayton, VIC, Australia,Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Susan V Harden
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Margaret Brand
- Department of Epidemiology & Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC, Australia,Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Dresler CM, Evans WK. Breathing Life Into Lung Cancer Screening Trials. J Thorac Oncol 2022; 17:1244-1246. [PMID: 37014163 DOI: 10.1016/j.jtho.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022]
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Caini S, Del Riccio M, Vettori V, D'Ecclesiis O, Bonomo P, Locatello LG, Salvestrini V, Gallo O, Tagliabue M, Raimondi S, Saieva C, Cozzolino F, Bendinelli B, Gandini S. Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis. Br J Cancer 2022; 127:1907-1915. [PMID: 35999273 PMCID: PMC9681856 DOI: 10.1038/s41416-022-01945-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: 04/03/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Cigarette smoking is the main risk factor for head and neck cancer (HNC) and many HNC patients are active smokers at diagnosis. We conducted a systematic literature review and meta-analysis to quantify the survival impact of smoking cessation at or around the time of HNC diagnosis. We searched studies published until December 31, 2021, and used random-effects meta-analysis to pool study-specific estimates into summary hazard ratio (SHR) and corresponding 95% confidence intervals (CI). Sixteen studies were published between 1983 and 2021, and over 2300 HNC patients were included. Studies were diverse in terms of design, patients, tumours and treatment characteristics, and criteria used to discriminate quitters from continued smokers. HNC patients who quit smoking at or around diagnosis had significantly better overall survival than continued smokers (SHR 0.80, 95% CI 0.70-0.91, n studies = 10). A beneficial effect of post-diagnosis smoking cessation was suggested for other survival endpoints as well, but the results were based on fewer studies (n = 5) and affected by publication bias. Cessation counselling should be offered to all smokers who start a diagnostic workup for HNC and should be considered standard multidisciplinary oncological care for HNC patients. PROSPERO registration number CRD42021245560.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Careggi University Hospital, Florence, Italy
| | | | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Flavia Cozzolino
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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Pastorino U, Ladisa V, Trussardo S, Sabia F, Rolli L, Valsecchi C, Ledda RE, Milanese G, Suatoni P, Boeri M, Sozzi G, Marchianò A, Munarini E, Boffi R, Gallus S, Apolone G. Cytisine Therapy Improved Smoking Cessation in the Randomized Screening and Multiple Intervention on Lung Epidemics Lung Cancer Screening Trial. J Thorac Oncol 2022; 17:1276-1286. [PMID: 35908731 DOI: 10.1016/j.jtho.2022.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Cytisine, a partial agonist-binding nicotine acetylcholine receptor, is a promising cessation intervention. We conducted a single-center, randomized, controlled trial (RCT) in Italy to assess the efficacy and tolerability of cytisine as a smoking cessation therapy among lung cancer screening participants. METHODS From July 2019 to March 2020, the Screening and Multiple Intervention on Lung Epidemics RCT enrolled 869 current heavy tobacco users in a low-dose computed tomography screening program, with a randomized comparison of pharmacologic intervention with cytisine plus counseling (N = 470) versus counseling alone (N = 399). The primary outcome was continuous smoking abstinence at 12 months, biochemically verified through carbon monoxide measurement. RESULTS At the 12-month follow-up, the quit rate was 32.1% (151 participants) in the intervention arm and 7.3% (29 participants) in the control arm. The adjusted OR of continuous abstinence was 7.2 (95% confidence interval: 4.6-11.2). Self-reported adverse events occurred more frequently in the intervention arm (399 events among 196 participants) than in the control arm (230 events among 133 participants, p < 0.01). The most common adverse events were gastrointestinal symptoms, comprising abdominal swelling, gastritis, and constipation. CONCLUSIONS The efficacy and safety observed in the Screening and Multiple Intervention on Lung Epidemics RCT indicate that cytisine, a very low-cost medication, is a useful treatment option for smoking cessation and a feasible strategy to improve low-dose computed tomography screening outcomes with a potential benefit for all-cause mortality.
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Affiliation(s)
- Ugo Pastorino
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
| | - Vito Ladisa
- Division of Pharmacy, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Trussardo
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Sabia
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Rolli
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Camilla Valsecchi
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta E Ledda
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy; Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Paola Suatoni
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfonso Marchianò
- Division of Radiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Munarini
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
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Bovio N, Grzebyk M, Arveux P, Bulliard JL, Chiolero A, Fournier E, Germann S, Konzelmann I, Maspoli M, Rapiti E, Guseva Canu I. Work-Related Factors and Lung Cancer Survival: A Population-Based Study in Switzerland (1990-2014). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13856. [PMID: 36360735 PMCID: PMC9657856 DOI: 10.3390/ijerph192113856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
While previous Swiss studies have demonstrated differences in lung cancer mortality between occupational groups, no estimates are available on the association of occupation-related factors with lung cancer survival. This study aimed at determining whether occupation or work-related factors after diagnosis affect lung cancer survival. We used cancer registry records to identify lung cancer patients diagnosed between 1990 and 2014 in western Switzerland (n = 5773) matched with the Swiss National Cohort. The effect of occupation, the skill level required for the occupation, and the socio-professional category on 5-year lung cancer survival was assessed using non-parametric and parametric methods, controlling for histological type and tumour stage. We found that the net survival varied across skill levels and that the lowest skill level was associated with worse survival in both men and women. In the parametric models with minimal adjustment, we identified several occupational groups at higher risk of mortality compared to the reference category, particularly among men. After adjustment for histological type of lung cancer and tumour stage at diagnosis, most hazard ratios remained higher than 1, though non-statistically significant. Compared to top managers and self-employed workers, workers in paid employment without specific information on occupation were identified as the most at-risk socio-professional category in nearly all models. As this study was conducted using a relatively small sample and limited set of covariates, further studies are required, taking into account smoking habits and administrated cancer treatments. Information on return to work and working conditions before and after lung cancer diagnosis will also be highly valuable for analysing their effect on net lung cancer survival in large nationwide or international studies. Such studies are essential for informing health and social protection systems, which should guarantee appropriate work conditions for cancer survivors, beneficial for their quality of life and survival.
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Affiliation(s)
- Nicolas Bovio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | - Michel Grzebyk
- Department of Occupational Epidemiology, National Research and Safety Institute (INRS), 54500 Vandoeuvre lès Nancy, France
| | - Patrick Arveux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory, University of Fribourg, 1700 Fribourg, Switzerland
- Valais Cancer Registry, Valais Health Observatory, 1950 Sion, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- School of Population and Global Health, McGill University, Montréal, QC H3A 1G1, Canada
| | - Evelyne Fournier
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland
| | - Simon Germann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | | | - Manuela Maspoli
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland
| | - Elisabetta Rapiti
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
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Stone E, Paul C. The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics. Curr Oncol 2022; 29:6325-6333. [PMID: 36135066 PMCID: PMC9497727 DOI: 10.3390/curroncol29090497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, Darlinghurst 2010, Australia
- School of Clinical Medicine, University of New South Wales, Sydney 2052, Australia
- School of Public Health, University of Sydney, Camperdown 2006, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan 2308, Australia
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Prognostic Impact of Post-Diagnosis Smoking Cessation among Bladder Cancer Patients: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14164022. [PMID: 36011016 PMCID: PMC9406768 DOI: 10.3390/cancers14164022] [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: 07/03/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
We reviewed the studies examining whether quitting smoking at or around diagnosis favourably affects the prognosis of bladder cancer (BC) patients, who are often active smokers at diagnosis. We found only nine eligible articles published until 31 January 2022, which encompassed around 5500 BC in total, the majority of which were nonmuscle invasive BC (only one paper included muscle-invasive BC). We used random effects meta-analysis to obtain a summary hazard ratio (SHR) and 95% confidence intervals (CI). The median proportion of smokers who quit at or around diagnosis was 29.8% (range 8.4-43.1%). For the overall, BC-specific, and progression-free survival, the studies were limited in number (n = 3) and provided conflicting results. At the same time, quitters did not appear to have a lower risk of recurrence than continued smokers (SHR 0.99, 95% CI 0.61-1.61). In conclusion, while the evidence is currently not sufficient to draw firm conclusions (especially for patients with muscle-invasive BC), physicians should not refrain from educating smoking BC patients about the benefits of smoking cessation and provide the necessary support.
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The Prognostic Impact of Quitting Smoking at or around Diagnosis on the Survival of Patients with Gastrointestinal Cancers: A Systematic Literature Review. Cancers (Basel) 2022; 14:cancers14163857. [PMID: 36010851 PMCID: PMC9406224 DOI: 10.3390/cancers14163857] [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: 07/18/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Smokers are at high risk of cancer of the gastrointestinal system, and many patients with newly diagnosed cancer of the oesophagus, stomach, colon-rectum, and liver are active smokers at diagnosis. In this review, we focused on whether stopping smoking shortly before diagnosis or afterwards (e.g., during treatment) may improve the chance of survival for these patients. We reviewed the scientific literature up to April 2022 and found only seven articles focusing on this topic. While very limited in number, these studies provided suggestive evidence in favour of a beneficial effect of smoking cessation for these patients. Smokers with newly diagnosed cancer of the gastrointestinal system should be encouraged to stop smoking and provided all the necessary support to achieve this goal. Abstract Cigarette smoking is a strong risk factor for the occurrence of gastrointestinal cancers, and a substantial proportion of newly diagnosed patients is made up of active smokers, yet the impact of smoking cessation at or around diagnosis on the clinical course of these cancers (whose prognosis is often unfavourable) has never been summarized to date. We reviewed studies published until 30 April 2022 that investigated whether smoking cessation at or around diagnosis favourably affects the clinical course of gastrointestinal cancers patients. Six studies were included for colorectal cancer patients, which provided limited yet suggestive evidence that quitters may have longer disease-specific survival compared to continued smokers. Only one study each focused on patients with gastric or HBV-positive liver cancer (both reporting a survival advantage for quitters vs. continued smokers), while we found no eligible studies for patients with cancer at other sites within the digestive system. More research is urgently needed to expand the evidence on the topic, given the potentially major clinical implications for these patients. Moreover, health professionals should provide the necessary smoking cessation support to any smoker who is undergoing diagnostic work-up or treatment for gastrointestinal cancer.
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