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Objective: To determine the relation between in-vitro establishment of tumor cell lines and survival in patients with non-small-cell lung cancer.Design: Cohort study.Setting: Single-institution tertiary care center.Patients: One hundred twenty-three consecutive patients with non-small-cell lung cancer from whom a viable tumor specimen could be obtained.Intervention: Tumor tissue was removed at the time of entry into a therapeutic protocol. The tumor tissue was processed in the laboratory for attempted cell-line establishment. Patients classified as potentially curable (stages I, II, and IIIA) were treated with surgical resection, radiation therapy, or a combination. Patients suitable for palliative therapy only (stages IIIB and IV) were treated with radiation therapy with or without chemotherapy. Chemotherapy was based on in-vitro drug sensitivity when available. Cell-line establishment was correlated to clinical outcome.Measurements and Main Results: Univariate analysis of survival was done using the log-rank test; multivariate analysis was done by Cox modeling step-up and step-down techniques. Cell lines were established from the tumor specimens of 25 patients (20%). Those patients experienced a median survival of 7 months compared with 18 months in patients from whom cell lines could not be established (P less than 0.001). In the 61 patients with potentially curable disease, 8 patients (13%) with cell lines established had a median survival of 8 months compared with 32 months for those without cell lines established (P = 0.001). In the 62 palliative group patients, the median survival of the 17 patients (27%) from whom tumor cell lines were established was 5 months compared with 7 months for those without cell lines (P = 0.15). Multivariate analysis in both groups showed cell-line establishment to be a significant indicator of prognosis (P less than 0.0001 for curable group; P less than 0.01 for palliative group).Conclusion: In-vitro tumor growth is related to decreased patient survival, which in turn reflects the biologic aggressiveness of cancers giving rise to these tumor cell lines. [ABSTRACT FROM AUTHOR]

Background: Large segments of the US population do not receive quality cancer care due to pervasive and systemic inequities, which can increase morbidity and mortality. Multicomponent, multilevel interventions can address inequities and improve care, but only if they reach communities with suboptimal access. Intervention studies often underenroll individuals from historically excluded groups., Methods: The Alliance to Advance Patient-Centered Cancer Care includes 6 grantees across the United States who implemented unique multicomponent, multilevel intervention programs with common goals of reducing disparities, increasing engagement, and improving the quality of care for targeted populations. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the evaluation efforts across sites. Each Alliance site identified their intended populations, which included underrepresented minorities (eg, Black and Latinx persons), individuals who prefer a language other than English, and rural residents. We evaluated the demographic characteristics of participants to determine program reach., Results: Between 2018 and 2020, a total of 2,390 of 5,309 potentially eligible participants were enrolled across the 6 sites. The proportion of enrolled individuals with selected characteristics included 38% (n=908) Black adults, 24% (n=574) Latinx adults, 19% (n=454) preferring a language other than English, and 30% (n=717) rural residents. The proportion of those enrolled who were the intended population was commensurate to the proportion with desired characteristics in those identified as potentially eligible., Conclusions: The grantees met or exceeded enrollments from their intended populations who have been underserved by quality cancer care into patient-centered intervention programs. Intentional application of recruitment/engagement strategies is needed to reach individuals from historically underserved communities.

Background: In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking., Objective: To assess health-care professionals' self-perceived competencies regarding the provision of EOL care in hospitalized patients., Methods: Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups., Results: A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers., Conclusions: Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

Psychological distress, including anxiety and depression, is commonly reported by patients with implantable left ventricular assist devices (LVADs). Still, the influence of anxiety and depression on global quality of life (QOL) is unknown. Moreover, the empirical data of LVAD patients' QOL is limited to 24 months. This study examined the differences in anxiety, depression, and QOL based on 3 LVAD implant duration groups (≤12, 13-24, and ≥25 months). We also examined the influence of anxiety and depression on QOL. An observational cross-sectional study design was employed using self-administered demographics, anxiety, depression, and global QOL questionnaires. A total of 100 patients (mean age 52 ± 13.3 years) across the United States completed the study. In the 3 implant duration groups, we found no significant differences in anxiety and depression, but the global QOL scores of patients with LVADs ≥ 13 months were significantly worse than those of patients with LVADs ≤ 12 months. Also, the correlations between QOL and either anxiety or depression were significant: Pearson's r ranged from -0.44 to -0.65 with all p values <0.0001. Compared with anxiety, depression is a stronger predictor of QOL. Our data showed that when depression is increased by 1 unit, the average QOL decreased by 0.76 units, assuming anxiety is held constant. This study uncovered relationships among anxiety, depression, and QOL in patients with long-term LVADs. Longitudinal research is needed to confirm our findings and explore factors that may contribute to worse QOL, particularly, those patients supported with LVADs beyond 13 months.

Background: Asthma affects >300 million people globally, including 25 million in the United States. Patients with asthma frequently use the Internet as a source of information. YouTube is one of the three most popular Web sites., Objective: To determine the educational quality of YouTube videos for asthma., Methods: We performed a YouTube search by using the keyword "asthma." The 200 most frequently viewed relevant videos were included in the study. Asthma videos were analyzed for characteristics, source, and content. Source was further classified as asthma health care provider, other health care provider, patient, pharmaceutical company, and professional society and/or media. A scoring system was created to evaluate quality (-10 to 30 points). Negative points were assigned for misleading information., Results: Two hundred videos were analyzed, with a median of 18,073.5 views, 31.5 likes, and 2 dislikes, which spanned a median of 172 seconds. More video presenters were male (60.5%). The most common type of video source was other health care providers (34.5%). The most common video content was alternative treatments (38.0%), including live-fish ingestion; reflexology; acupressure and/or acupuncture; Ayurveda; yoga; raw food, vegan, gluten-free diets; marijuana; Buteyko breathing; and salt therapy. Scores for videos supplied by asthma health care providers were statistically significantly different from other sources (p < 0.001) and had the highest average score (9.91)., Conclusion: YouTube videos of asthma were frequently viewed but were a poor source of accurate health care information. Videos by asthma health care providers were rated highest in quality. The allergy/immunology community has a clear opportunity to enhance the value of educational material on YouTube.

Seventy-one ductal carcinoma in situ (DCIS) patients were reported to the tumor registry at the National Naval Medical Center between 1986 and 1995. This number represents 6.5% of all breast cancer patients. We did not include the patients with microinvasion or infiltrating ductal carcinoma with extensive DCIS in this study. After excluding 16 cases because of inaccessable clinical records, 55 cases of pure DCIS were analyzed. The mean age at presentation was 52.0 years (32 year-old to 74 year-old) and the most common clinical feature was an abnormal mammographic finding (40 cases, 73%). Family history of breast cancer was positive in 14 cases among the 39 cases with DCIS (35.9%) according to the medical records. Total mastectomy was the most common form of treatment for DCIS (19 cases, 34.5%) during this period, followed by modified radical mastectomy, lumpectomy only, lumpectomy with radiation therapy. Three hundred and two axillary lymph nodes were examined but revealed no nodal metastasis. Comedo type DCIS was the most common subtype (21 cases, 38.2%). There were no local recurrences or DCIS related deaths reported to the tumor registry during this period (mean follow-up interval of 51 months).

The outcome was determined for patients with Stage I cancers of the large bowel (colon, rectum, and anus) who were treated from 1982-1989. In 119 consecutive patients, the 5-year survival was approximately 70% (72% by the absolute direct method; 67% by the actuarial life table method). Although the overall 5-year survival was similar to numerous other published reports, it was disturbing to observe that 41% of the living patients had relapsed. Furthermore, although 88/119 (67%) were alive at last report, 2-7 years after treatment, only 23 (19%) were believed to be free of cancer. We conclude that follow-up for more than 5 years and the assessment of disease-free survival are required to evaluate the outcome from Stage I large bowel cancer.