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Introduction: This study aimed to describe the patterns of palliative intent treatment and/or palliative care (PC) delivery among a population-based sample of individuals diagnosed with advanced nonsmall cell lung cancer (NSCLC) or advanced melanoma. Methods: Data from 655 advanced-stage melanoma patients and 2688 advanced-stage NSCLC patients included in the National Cancer Institute's 2017/2018 Patterns of Care study were analyzed. Bivariate and multivariate logistic regression analyses examined factors associated with (1) receipt of PC (including palliative surgery, radiation, and/or systemic therapy after cancer diagnosis, and PC consultations); and (2) timing from diagnosis to receipt of PC. Proportional hazards models also examined factors associated with timing of receipt of PC after diagnosis. Results: A total of 23.5% of those with melanoma and 52.6% of those with NSCLC received some type of PC. For melanoma, stage 4 (vs. stage 3) was associated with higher receipt of PC and receipt within three months of diagnosis. For NSCLC, stage 4 (vs. stage 3) and a diagnosis of depression or psychosocial distress within three months of diagnosis were significantly associated with receipt of PC and receipt within three months of diagnosis. Conclusion: Study findings indicate that those with advanced-stage cancer or who report distress are more likely to receive palliative intent treatment and/or PC. Given that individuals with advanced cancers are living longer and often experience long-lasting symptoms, it is critical to identify and overcome barriers for broadly delivering comprehensive palliative and supportive care. [ABSTRACT FROM AUTHOR]

Introduction: Pembrolizumab, an anticancer immunotherapy agent, has received multiple approvals since its first approval by the U.S. Food and Drug Administration (FDA) in 2014. Limited data exist on its real‐world use and shifts post tumor‐agnostic approval in 2017 for the treatment of patients with any microsatellite instability‐high/mismatch repair deficient (MSI‐H/dMMR) solid tumors. This study analyzes pembrolizumab's pre and post‐tumor‐agnostic approval use among older U.S. adults, revealing its evolving role in oncology practice. Methods: Using the Surveillance, Epidemiology and End Results (SEER)‐Medicare data (2014–2019), we examined the cancer sites of pembrolizumab recipients before and after tumor‐agnostic approval. Cancer sites were classified based on the timing of site‐specific approvals (before/after tumor‐agnostic approval) or no site‐specific approval, and inclusion in MSI‐H/dMMR clinical trials. Results: The total number of pembrolizumab recipients increased from 4221 in the pre‐agnostic period to 20 479 in the post‐agnostic period. Pembrolizumab was used for a broad range of cancer types, including cancers that had no FDA‐approved site‐specific indications at the time of use (25.8% in pre‐ and 24.6% in post‐agnostic periods). The proportion of pembrolizumab recipients receiving pembrolizumab for cancers with site‐specific approvals before tumor‐agnostic approval decreased from 77.3% to 70.8%. The proportion of pembrolizumab recipients receiving pembrolizumab for cancers that gained site‐specific approvals following tumor‐agnostic approval almost doubled (6.8% to 13.0%). The proportion of pembrolizumab recipients with cancers included in MSI‐H/dMMR trials also doubled (12.3% to 25.5%) following tumor‐agnostic approval. Conclusions: Pembrolizumab use has expanded over time among older adults with cancer, extending beyond those with FDA‐approved site‐specific indications. [ABSTRACT FROM AUTHOR]

Current US lung cancer screening recommendations limit eligibility to adults with a pack‐year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20‐PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer‐related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations. [ABSTRACT FROM AUTHOR]

This study aims to assess disparities in the surgical treatment of women with locoregional endometrial carcinoma (EC) utilizing a large national cancer database. The Surveillance, Epidemiology and End Results Program (SEER)-Medicare linked resource was used to analyze data from women with loco-regional EC treated in the United States from 2009-2017 who underwent a hysterectomy and were enrolled in Medicare. This is a retrospective cohort study. Total of 26,398 women met inclusion criteria. Most patients (17,921; 67.9%) underwent minimally invasive surgery (MIS). The percentage of patients undergoing MIS for EC significantly increased with time from 53% in 2009-2011 to 79% in 2015-2017 (p < 0.0001). Most non-Hispanic Black patients underwent laparotomy (1066 of 2091; 51%); most non-Hispanic White and Hispanic patients underwent MIS (non-Hispanic White: 15,127 of 21,555; 70%, Hispanic: 992 of 1632; 61%, p < 0.0001). A lower proportion of women with dual Medicare/Medicaid underwent MIS (59% vs. 70%, p < 0.0001). Centers with "Teaching Hospital" designation had significantly higher rates of MIS (p < 0.0001); "Sole Community" designation centers had significantly lower rates of MIS (p < 0.0001). Readmissions for surgical complications within 30 days of surgery were more frequent in the laparotomy cohort (p < 0.0001). On multivariate analysis, an increased hazard for death was observed among women who underwent laparotomy (Hazard Ratio (HR) 1.423; 95% Confidence Interval (CI) 1.345-1.507; p < 0.0001). These differences remained when analyzing women with localized and those with regional disease separately. We demonstrate both patient and organization-level differences between those who received laparotomy versus MIS for surgical management of EC. [ABSTRACT FROM AUTHOR]

Climate scientists have received threatening letters and e-mails for years. Their names have been dragged through the mud in congressional hearings, on newspaper editorial pages, on talk-radio shows, and in their home communities by those seeking to distract and mislead the public. Despite the continued harassment, however, scientists were still winning in the court of public opinion. The majority of the public understood that the overwhelming body of evidence supports the theory that the earth is warming and that humans are contributing significantly to the warming. Scientists and the organizations that represent them had made significant headway in helping the public and policy makers better understand what is happening and what can be done to mitigate and adapt to changes in the earth's climate. In this article, the author argues that when scientists are attacked professionally and personally, independent science and the public suffer. He discusses how ideological attacks on scientists undermine sound public policy.