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Background: The Internet may provide an alternative option for rural lung cancer patients who lack access to on-site cancer support; however, Internet access and use among rural patients is unknown., Methods: An anonymous waiting-room survey was administered to all outpatient cardiothoracic surgery patients over 3 mo. Survey questions included age, gender, and diagnosis, possession of a home computer and Internet service, estimated Internet use, and use of the Internet for health information. Patients with known or suspected lung cancer were asked to indicate their interest in on-site and Internet cancer support., Results: There were 597 returned surveys (response rate 96%). The mean age was 64.6 y (SE 0.55), and 58% were men. Diagnoses included known or possible lung cancer (15.4%), lung disease (9.5%), heart disease (30.4%), other diagnoses (13.9%), and undetermined (30.6%). There were 343 patients (57.4%) with a home computer and 299 (50.1%) with home Internet service. Average Internet use was 8.5 h per wk (n = 298), and 225 patients used the Internet for health information. Of the 92 patients with lung cancer, 10 indicated interest in on-site support services while 37 expressed interest in Internet-based support., Conclusions: Based on survey results, a slight majority of rural patients have a home computer and Internet access. Internet use for health information appears relatively common. Overall interest for support services among lung cancer patients appears modest with a greater interest in Internet-based services compared with on-site support., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: Few studies have examined the accuracy of patient-reported international normalized (INR) values for home anticoagulation testing (HAT). Our study objectives were to assess this accuracy and compare the percentage time within therapeutic range (PTWTR) based on HAT data to that obtained with testing through an anticoagulation clinic service (ACS)., Materials and Methods: Forty-nine anticoagulated patients were enrolled in a year-long, prospective, crossover study comparing HAT to ACS testing. Patients performed HAT for 6 months and telephoned their INR values. Thereafter, devices were interrogated for the 30 most recent INR readings. Data accuracy was calculated for each patient as the percentage of correctly telephoned INR values divided by the total number of INR values common to both the device and the telephone logs. The device-based PTWTR was compared to the PTWTR based on ACS data., Results: Of the 49 enrolled patients, 32 completed the study protocol. The mean accuracy of reporting was 94.0 +/- 13.0% (range, 48-100%); the median accuracy was 100%. Three patients had marked low accuracy (48, 60, 62%). No significant difference was seen between the PTWTR based on device data versus that obtained though the ACS (59.8 +/- 15.7% versus 59.5 +/- 19.4%, P=0.48)., Conclusions: The overall accuracy of patient-reported INR values is high and the PTWTR found with HAT is comparable to that obtained with clinic testing. However, the potential for noncompliance in a small number of patients raises the question of whether periodic confirmation of patient-reported INR values should be considered.

Background: Home anticoagulation testing (HAT) may be useful for rural patients who cannot attend an anticoagulation service clinic (ASC). Interest in HAT is unknown and was the focus of this study., Materials and Methods: Anticoagulated patients from two clinics, the ASC and vascular surgery clinic (VSC) were surveyed and compared for demographics, anticoagulation knowledge and opinions, and HAT interest. Logistic regression was performed, using the entire patient cohort, to identify factors associated with HAT interest., Results: There were 211 (141 ASC, 70 VSC) patients surveyed. Differences between the ASC and VSC patients included education level (13.2 versus 12.1 years; P = 0.02), time spent testing (60.5 +/- 33.5 versus 46.4 +/- 20.7 min; P = 0.001), use of fingerstick testing (90% versus 2.9%; P < 0.001), and knowledge of the potential interaction of warfarin with medications or diet (79% versus 59% P = 0.003). HAT interest was similar (62.1% ASC versus 50% VSC; P = 0.14). Factors associated with HAT interest included employment [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2-6.7], knowledge of potential interactions between medications and warfarin (OR 3.9, 95% CI 1.9-8.1), and a willingness to check international normalized ratio values more frequently if recommended (OR 2.4, 95% CI 1.2-4.6). Patients who received family help with medications appeared less interested in HAT (OR 0.29, 95% CI 0.12-0.68)., Conclusions: A slight majority of surveyed rural patients conveyed interest in HAT. Working patients and those assuming more responsibility for international normalized ratio control may be more interested in HAT. A possible association between anticoagulation knowledge and increased HAT interest was seen and should be further studied.

Background: In vitro studies have shown that Vitamin E succinate (VES) arrests lung cancer proliferation; however, in vivo studies have not been performed. This study examined in vivo effects of VES on lung cancer., Methods: An in vitro dose-response curve of human A549 lung cancer tumors to VES was established. A549 tumors were established in the right submammary fat pads of athymic nude mice (C57/BL/6J-Hfh11nu). Seven days after injection, mice were separated into VES and control groups. VES mice (n = 12) underwent daily intraperitoneal (IP) injection of VES (150 mg/kg in 7% dimethyl sulfoxide, 93% polyethylene glycol); control mice (n = 11) were injected with vehicle only. At 27 days, harvested tumors were measured and weighed. Lungs were stained for metastases using hematoxylin-eosin. Tumor volume and weights were compared using a two-sample t test. Tumor growth curves were compared using a mixed model analysis of variance., Results: In vitro studies demonstrated dose-dependent manner inhibition of A549 cell proliferation by VES (IC(50) 18 mug/mL). Tumor volumes and weights differed significantly between VES and control mice with volumes of 192.6 +/- 20.4 mm(3)versus 292.9 +/- 31.4 mm(3) (P = 0.01) and weights of 168.6 +/- 20.0 mg versus 255.7 +/- 37.0 mg, respectively (P = 0.05). Tumor growth differed significantly (P < 0.001). Both groups of mice showed pulmonary metastases., Conclusions: Lung cancer cells appear to respond to VES, albeit incompletely. Because tumor cell response is seen, lung cancer patients may derive some benefit from VES and should be considered in eventual clinical studies using this vitamin E derivative.