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Background: Patients at the Philadelphia Veterans Affairs Medical Center frequently voice concern that air exposure during lung cancer surgery might cause tumor spread. Several African-American patients asserted that this belief was common in the African- American community. Objective: To assess the prevalence of the belief that air expo- sure during lung cancer surgery might cause tumor spread and gauge the influence of this belief on the willingness of African- American and white patients to have lung cancer surgery. Design: Prospective questionnaire survey. Setting: Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Los Angeles Veterans Affairs Medical Center, Los Angeles, California; and Medical University of South Carolina, Charleston, South Carolina. Patients: 626 consecutive patients in pulmonary and lung cancer clinics. Measurements: None. Results: 38% of patients (61% of whom were African American and 29% of whom were white) stated that they believe air expo- sure at surgery causes tumor spread. The most significant predictor of belief was African-American race (odds ratio, 3.5 [95% CI, 1.9 to 6.5]), even after controlling for other relevant variables in a multivariable analysis. Nineteen percent of African Americans stated that this belief was a reason for opposing surgery, and 14% would not accept their physicians' assertion that the belief is false. These rates were also statistically significantly higher among African-American than white patients. Conclusions: Belief in accelerated tumor spread at surgery is prevalent among general pulmonary outpatients and lung cancer clinic patients facing lung surgery, particularly among African- American patients. Our findings may pertain to key racial disparities in lung cancer surgery and survival rates and suggest. [ABSTRACT FROM AUTHOR]

Purpose: Compared to European Americans (EAs), African Americans (AAs) suffer a disproportionate share of the lung cancer mortality burden. To investigate whether this disparity in lung cancer mortality is due to differential racial risks related to socioeconomic status (education, occupation), body mass index (BMI), hypertension, or cigarette smoking, we compared associations between these factors and lung cancer mortality by race in a biracial prospective cohort study. Methods: The Charleston (South Carolina) Heart Study (N = 2,054) was established in 1960; 40% of the study participants are AAs. The participants have been followed up for mortality for 40 years. Using Cox proportional hazards models, we investigated whether there were racial differences in the associations between the study factors and lung cancer mortality. Results: Cigarette smoking was the strongest lung cancer risk factor in both races. The association between cigarette smoking and lung cancer mortality was stronger in EAs than AAs (hazards ratio [HR] 26.1 vs. 7.6). In both races, men were at significantly greater risk than women and BMI was significantly inversely associated with lung cancer mortality. Conclusions: The evidence from the present study does not yield strong clues for the excess lung cancer mortality in AAs. Our results do not support the hypothesis that differential susceptibility to cigarette smoking is a major contributor to the racial disparity in lung cancer. This suggests we must expand our scope of inquiry beyond the factors included in the present study to fully understand why lung cancer mortality rates are greater in AAs than EAs. [Copyright &y& Elsevier]

Background: Incorporating tobacco treatment within lung cancer screening programs has the potential to influence cessation in high-risk smokers. We aimed to better understand the characteristics of smokers within a screening cohort, correlate those variables with downstream outcomes, and identify predictors of continued smoking., Methods: This study is a secondary analysis of the National Lung Screening Trial randomized clinical study. Tobacco dependence was evaluated by using the Fagerstrӧm Test for Nicotine Dependence, the Heaviness of Smoking Index, and time to first cigarette (TTFC); descriptive statistics were performed. Clinical outcomes (smoking cessation, lung cancer, and mortality) were assessed with descriptive statistics and χ 2 tests stratified according to nicotine dependence. Logistic and Cox regression models were used to study the influence of dependence on smoking cessation and mortality, respectively., Results: Patients with high dependence scores were less likely to quit smoking compared with low dependence smokers (TTFC OR, 0.50 [95% CI, 0.42-0.60]). Indicators of high dependence, as measured according to all three metrics, were associated with worsening clinical outcomes. TTFC showed that patients who smoked within 5 min of waking (indicating higher dependence) had higher rates of lung cancer (2.07% for > 60 min after waking vs 5.92% ≤ 5 min after waking; hazard ratio [HR], 2.56 [95% CI, 1.49-4.41]), all-cause mortality (5.38% for > 60 min vs 11.21% ≤ 5 min; HR, 2.19 [95% CI, 1.55-3.09]), and lung cancer-specific mortality (0.55% for > 60 min vs 2.92% for ≤ 5 min; HR, 4.46 [95% CI, 1.63-12.21])., Conclusions: Using TTFC, a one-question assessment of tobacco dependence, at the time of lung cancer screening has implications for personalizing tobacco treatment and improving risk assessment., (Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: The aim was to investigate whether differential risks from cigarette smoking contribute to the disproportionate burden of tobacco-related malignancies other than lung cancer (TRM-nonLC) suffered by African Americans (AAs) compared to Caucasians., Materials and Methods: Data from two prospective cohort studies (39% AAs) established in 1960 and followed through 1990 and 2000 in the southeastern U.S. were pooled (N=5,363). Each cohort had 30 years minimum follow-up., Results: Compared to Caucasians, the association between cigarette smoking and TRM-nonLC was significantly weaker in the AA men (hazards ratio (HR) 1.0 in AA men versus 3.6 in Caucasian men) and non-significantly weaker in the AA women (HR 1.1 in AA women versus 2.7 in Caucasian women)., Conclusion: In these study cohorts, differential susceptibility to tobacco-caused carcinogenesis was, by itself, an unlikely contributing factor to the racial disparity in tobacco-related malignancies.

Background: Early studies using Medicare data reported racial disparities in surgical treatment of localized, non-small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non-small cell lung cancer, controlling for comorbidity and socioeconomic status., Methods: All cases of localized non-small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using chi(2) tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression., Results: We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55)., Conclusions: Underuse of surgical resection for localized, non-small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system-related factors underlying these observations and optimize resection rates for non-small cell lung cancer.

Background: Retrospective analysis of patients with medically inoperable non-small cell lung cancer treated with continuous high-dose external beam radiation therapy at the Medical University of South Carolina., Methods: We identified 35 patients with non-small cell lung cancer treated 1998-2002. None were candidates for resection for reasons including: pulmonary function (n = 23), previous cancer (n = 9), other co-morbidities (n = 2), and refusal of surgery (n = 1). Median percent predicted forced expiratory volume in 1 second was 41.5%. Median age was 71 years. Five patients had more than one primary tumor: three were concurrently treated, two were sequentially treated. Lesion sizes were <3 cm (n = 24); 3-5 cm (n = 12), and >5 cm (n = 5). Nodal stage was as follows: N0 (n = 33) and N1 (n = 2). Radiation therapy was administered once daily: median dose was 80.5 Gy/35 fx/2.3 Gy/fx. The clinical target volume was tumor plus nodes > or =1.0 cm. V20 data were available for 12 patients, with a mean value of 15.7%., Results: Thirty-four patients completed treatment. Median follow-up was 23.0 months. There were 26 deaths: 19 died from non-small cell lung (73%) and seven died from co-morbid illness (27%). Median survival was 24 months (95% CI, 18.0-31.9 months). Four patients were alive with disease, and five were alive disease-free at 10- and 68-month follow-ups. Of 41 lesions, local failure occurred in 15 lesions (37%) of which 3 local failure patients (9%) failed concomitantly in untreated regional lymph nodes. There were no isolated nodal recurrences. Distant progression: 10 patients (29%) of which 6 distant progression without local failure. Two patients who both had prior lobectomies experienced grade 5 toxicities., Conclusion: Continuous high-dose external beam radiation therapy 80.5 Gy administered in 35 fractions was tolerated. Treatment-related death was rare (6%) and isolated to patients with prior lobectomies in an extremely high-risk population. Most mortality was lung cancer-related. The dose of 80.5 Gy in 7 weeks is supported for patients with single lesions and no prior lobectomy. Local failure dominates and higher effective doses should be explored.