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About one-third to one-half of patients with early stages of non-small cell lung cancer (NSCLC) succumb to their disease. In this study, we attempted to identify prognostic factors that predict outcome in patients with stages I and II NSCLC.A retrospective evaluation of 454 patients with surgically resected stages I and II NSCLC was performed to determine the impact of various clinical, laboratory, and pathological factors on patient outcome such as overall survival (OS) and event-free survival (EFS).Patients older than 65 years had shorter EFS and OS than younger patients (p = 0.002). Patients with preoperative hemoglobin less than or equal to 10 g% had shorter EFS and OS compared to patients with a hemoglobin greater than 10 g% (p = 0.001). Expectedly, OS and EFS were shorter in patients with stage II as compared to stage I patients (p0.001). In a multivariate analysis, age, hemoglobin level, and stage remain significant predictors for EFS and OS.Older age, anemia, and higher stage are important prognostic factors in patients with surgically resected stage I and II NSCLC.

What were the needs of outpatients for symptom management?A multidisciplinary team assembled to determine the need for a symptom management clinic. Two surveys were developed for potential users: one for the outpatients and the other for the attending oncologists.During a 3-week period, outpatients were approached after registering for the oncology clinic and while waiting for their appointment. Ninety-five percent of the outpatients approached completed the survey.A total of 112 surveys revealed that outpatients would attend a symptom management clinic for relief of pain (50%), fatigue (40%), nausea/vomiting (30%), and/or sleeping difficulty (30%). A total of 16 surveys completed by oncologists revealed that outpatients could use more assistance with pain (81%), diet (75%), depression (69%), and/or fatigue (56%). Outpatients felt they would benefit from meeting with a nurse (35%), social worker (21%), dietician (18%), and/or pharmacist (18%). While oncologists thought that the following would complement care: dietician (69%), psychologist (69%), nurse (56%), and/or social worker (56%). Fifty-one percent of the outpatients indicated that they would attend a symptom management clinic and all but one oncologist would refer to this clinic.While there exists some disconnect between perceived need for symptom management between outpatient and oncologist, it is evident that pain is the symptom of primary concern. An interdisciplinary team of oncologist, nurse, social worker, dietician, pharmacist, and psychologist could collaboratively address the presenting symptoms. Users, both outpatients and oncologists perceive benefit from a collaborative and interdisciplinary symptom management clinic.

Introduction Denileukin diftitox, a chimeric protein, uses the cytocidal properties of diphtheria toxin to cells expressing interleukin-2 receptors. The aim of this study was to evaluate the efficacy and safety of denileukin diftitox in the treatment of advanced relapsed nonsmall cell lung cancer (NSCLC). Patients and methods Multicenter phase II trial in patients with NSCLC with Eastern Cooperative Oncology Group PS 0-2, stage IIIB/IV at diagnosis, who had failed at least 1 previous chemotherapy regimen. Denileukin diftitox was infused at 18 microg/kg/d x 5 days, every 21 days for 6 cycles. Results For the 41 patients enrolled, the median age was 56 years (range, 21-80), 25 were men, and the median number of previous chemotherapy regimens was 2 (range, 1-5). The median number of treatment cycles was 2 (range, 1-6). By RECIST criteria, 18 (44%) had stable disease, 10 (24%) progressive disease, and 13 (32%) were not evaluable for response as they received less than 2 treatment cycles. The median time to disease progression was 1.8 months [range, 0.3-11.3; 95% confidence interval (CI) 1.3-2.6]. Median survival was 5.8 months (range, 0.3-33.6; 95% CI 3.4-11.4). The median follow-up time was 16.1 month. One death from myocarditis verified at autopsy was attributed to treatment. One grade 4 toxicity (vascular leak syndrome) was encountered, and 18 grade 3 toxicities, primarily gastro-intestinal, vascular leak syndrome, and constitutional symptoms. Conclusion Denileukin diftitox at current dose schedule has limited activity in patients with previously treated NSCLC, manifested by disease control without impact on survival.

This study compared mammography rates in Arkansas, based on race and age, to identify any disparities in obtaining mammography.The Arkansas Mammography Data Collection Project contained data on 133,549 women, 87,680 of them aged 40 to 64 and 45,869 aged 65 years or older. Race data were available on 64,526 women. Mammography rates were compared by patient age and race.Women aged 65 years and older were less likely to obtain mammograms than younger women: 21.67% versus 23.30%. Mammograms were more likely to be classified as diagnostic in older women and as screening in younger women. Older African American women were less likely to obtain mammograms than younger women of the same race (7.23% vs 8.02%), while older white women were more likely to obtain mammograms than younger white women (11.64% vs 11.31%). African Americans were less likely to obtain mammograms in both age groups.Older African American women are less likely to obtain mammograms than white and younger women. The reasons for this disparity warrant further evaluation.

This study describes the characteristics, management, and outcomes of patients with unresected early-stage non-small cell lung cancer (NSCLC).A retrospective review was conducted to identify all patients with unresected stage I or stage II NSCLC diagnosed between 1990 and 1998.Ninety-seven patients were identified who met our criteria. The median age at diagnosis was 68 years; 78% of patients were white, 81% were male, 81% had stage I disease, and 67% had squamous cell carcinoma. Cancer-specific treatment, including chemotherapy, radiation therapy, and combined chemotherapy and radiation therapy, was administered to only 27 patients. The median survival time was 22 months for the treated group and 11 months for the untreated group.The majority of patients with unresected early-stage NSCLC do not receive cancer therapy. They should be thoroughly considered for treatment, however, especially in light of recent advances in surgery and radiation therapy, and the development of more active, less toxic chemotherapeutic agents.

Background Breast cancer is the most frequent cause of cancer death in women worldwide, but global disparities in breast cancer control persist, due to a lack of a comprehensive breast cancer control strategy in many countries. Objectives To identify and compare the need for breast cancer control strategies in Asia, Latin America and the Middle East/North Africa and to develop a common framework to guide the development of national breast cancer control strategies. Methods Data were derived from open-ended, semi-structured interviews conducted in 2007 with 221 clinicians, policy makers, and patient advocates; stratified across Asia (n = 97), Latin America (n = 46), the Middle East/North Africa (ME/NA) (n = 39) and Australia and Canada (n = 39). Respondents were identified using purposive and snowballing sampling. Interpretation of the data utilized interpretive phenomenological analysis where transcripts and field notes were coded and analyzed and common themes were identified. Analysis of regional variation was conducted based on the frequency of discussion and the writing of the manuscript followed the RATS guidelines. Results Analysis revealed four major themes that form the foundation for developing national breast cancer control strategies: 1) building capacity; 2) developing evidence; 3) removing barriers; and 4) promoting advocacy - each specified across five sub-ordinate dimensions. The propensity to discuss most dimensions was similar across regions, but managing advocacy was discussed more frequently (p = 0.004) and organized advocacy was discussed less frequently (p < 0.001) in Australia and Canada. Conclusions This unique research identified common themes for the development of breast cancer control strategies, grounded in the experience of local practitioners, policy makers and advocacy leaders across diverse regions. Future research should be aimed at gathering a wider array of experiences, including those of patients.