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PURPOSE Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients. METHODS We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population. RESULTS We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice. CONCLUSIONS Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application. Key words: lung cancer screening; preventive medicine; comorbidities; multimorbidity; clinical reasoning; judgment; paternalism; beneficence; personal autonomy; risk-benefit assessment; life expectancy; quality of life; counseling; education of patients; shared decision making; patient-centered care; holistic health; primary care; practice-based research, INTRODUCTION The United States Preventive Services Task Force (USPSTF) guidelines recommend lung cancer screening (LCS), with an annual low dose-computed tomography scan of the chest, for individuals who meet age [...]

PURPOSE Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS. METHODS We interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making. RESULTS Patients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screen-detected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures. CONCLUSIONS Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations. Key words: lung cancer; lung cancer screening; qualitative methods: key informant/depth interviewing; cancer: screening; chronic care: comorbidity/multimorbidity; primary care issues: patient-centered care, INTRODUCTION Achieving mortality reduction with lung cancer screening (LCS) (1,2) while minimizing iatrogenic harm requires optimizing patient selection: screening people likely to benefit from early detection and not screening those [...]

Byline: Sami. Bennji, B. Jayakrishnan, Adil. Al-Kindi, Issa. Al-Jahdhami, Zamzam. Al-Hashami Lung cancer is the leading cause of cancer-related death worldwide among both men and women. Although advances in therapy [...]

Potentiating radiotherapy and chemotherapy by inhibiting DNA damage repair is proposed as a therapeutic strategy to improve outcomes for patients with solid tumors. However, this approach risks enhancing normal tissue toxicity as much as tumor toxicity, thereby limiting its translational impact. Using NU5455, a newly identified highly selective oral inhibitor of DNA-dependent protein kinase catalytic subunit (DNA-PKcs) activity, we found that it was indeed possible to preferentially augment the effect of targeted radiotherapy on human orthotopic lung tumors without influencing acute DNA damage or a late radiation-induced toxicity (fibrosis) to normal mouse lung. Furthermore, while NU5455 administration increased both the efficacy and the toxicity of a parenterally administered topoisomerase inhibitor, it enhanced the activity of doxorubicin released locally in liver tumor xenografts without inducing any adverse effect. This strategy is particularly relevant to hepatocellular cancer, which is treated clinically with localized drug-eluting beads and for which DNA-PKcs activity is reported to confer resistance to treatment. We conclude that transient pharmacological inhibition of DNA-PKcs activity is effective and tolerable when combined with localized DNA-damaging therapies and thus has promising clinical potential., Introduction The activity of DNA-dependent protein kinase (DNA-PK) is essential to the repair of DNA double-strand breaks (DNA-DSBs) via canonical nonhomologous end joining (NHEJ) (1, 2). This repair mechanism involves [...]

Combined exposure to tobacco smoke and radon increases lung cancer risk, and renters are disproportionately exposed to secondhand smoke (SHS). A quota sample of renters (N = 47) received free radon and airborne nicotine test kits in a primary care setting to explore the impact of a personalized environmental report-back intervention on home exposure. Half of the sampled renters reported smokers living in the home. Taking actions to reduce radon and SHS exposure were assessed at baseline, and at 3-, 9-, and 15-months postintervention; home testing occurred at baseline and at 15 months. Stage of action in home testing and in adopting a smoke-free (SF) home policy increased from baseline to 3 months; we observed no further changes in stage of action over time. Airborne nicotine declined from baseline to 15 months (p = .031; n = 9). More research is needed to evaluate interventions to motivate renters and landlords to test and mitigate for radon and adopt SF policies., Introduction Lung cancer is the leading cause of cancer death in the U.S.; an estimated 222,500 new cases and 155,870 deaths were projected in 2017 (National Cancer Institute, n.d.). Smoking [...]

In this installment of Tales of the Clinic: The Art of Psychiatry, we follow a psycho-oncology case of lung cancer, compounded by depressive and anxiety symptoms. Faced with fear of [...]

Kentucky homeowners requesting radon test kits through the Kentucky Radon Program and randomly selected homeowners (N = 129) completed a survey assessing factors related to their radon testing intentions and perceived severity of radon exposure, including social influence, perceived susceptibility, synergistic risk perception, and tobacco use. Perceived severity, social influence, and current smoking were the strongest predictors of radon testing intentions. Those with higher perceived severity were nearly eight times more likely to plan to test. Perceived severity was highest among females and those rating combined radon and tobacco smoke exposure as much riskier than tobacco smoke alone. Knowing someone who had tested for radon was associated with seven times greater likelihood of planning to test for radon. Current smokers were over six times more likely to plan to test than nonsmokers. The findings have implications for targeting interventions to improve residential radon testing and decrease lung cancer risk., Introduction Radon is one of four top environmental risks to public health (Reuben, 2010). Exposure to radon, a naturally occurring gas derived from the decomposition of uranium in the ground, [...]

Individuals diagnosed with lung and head and neck (HN) cancers and their spouses are at increased risk for distress. This study assessed whether the way couples communicate about cancer and their perceptions of relationship intimacy influenced both partners' adjustment. One-hundred thirty-nine patients and their spouses [For purposes of clarity, we refer to the patients' intimate partner as the spouse, regardless of actual marital status and we reserve the term partner to refer to the other person in the couple (i.e., the patient's partner is the spouse and the spouse's partner is the patient)] completed measures of spousal communication, intimacy, and distress at three time points over 6 months. Using multilevel modeling, an over-time actor-partner interdependence model was specified that examined whether intimacy mediated associations between one's own and one's partner's reports of communication at baseline and later distress. Patients and spouses who reported greater baseline distress reported more negative baseline communication as well as lower levels of intimacy and greater distress over time. Mediation analyses showed patients' and spouses' reports of positive spousal communication were associated with less subsequent distress largely through their effects on intimacy. Clinicians working with head and neck or lung cancer patients should assess communication and intimacy because both impact couples' distress. Keywords Couple communication * Interpersonal processes * Relationship intimacy * Psychological adaptation * Cancer, Introduction The diagnosis of lung or head and neck cancer can be very stressful for both patients and their spouses. Rates of distress among lung cancer (LC) patients have been [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.cell.2006.05.041 Byline: Pier Paolo Scaglioni (1)(2), Thomas M. Yung (1)(3), Lu Fan Cai (1)(3), Hediye Erdjument-Bromage (4), Andrew J. Kaufman (5), Bhuvanesh Singh (5), Julie Teruya-Feldstein (3), Paul Tempst (4), Pier Paolo Pandolfi (1)(3) Abstract: The PML tumor suppressor controls key pathways for growth suppression, induction of apoptosis, and cellular senescence. PML loss occurs frequently in human tumors through unknown posttranslational mechanisms. Casein kinase 2 (CK2) is oncogenic and frequently upregulated in human tumors. Here we show that CK2 regulates PML protein levels by promoting its ubiquitin-mediated degradation dependent on direct phosphorylation at Ser517. Consequently, PML mutants that are resistant to CK2 phosphorylation display increased tumor-suppressive functions. In a faithful mouse model of lung cancer, we demonstrate that Pml inactivation leads to increased tumorigenesis. Furthermore, CK2 pharmacological inhibition enhances the PML tumor-suppressive property in vivo. Importantly, we found an inverse correlation between CK2 kinase activity and PML protein levels in human lung cancer-derived cell lines and primary specimens. These data identify a key posttranslational mechanism that controls PML protein levels and provide therapeutic means toward PML restoration through CK2 inhibition. Author Affiliation: (1) Cancer Biology and Genetics Program, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA (2) Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA (3) Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA (4) Molecular Biology Program, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA (5) Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA Article History: Received 22 December 2005; Revised 28 March 2006; Accepted 15 May 2006 Article Note: (miscellaneous) Published: July 27, 2006