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PURPOSE: Little is known about serious illness conversations (SIC) conducted during telemedicine visits and their impact on end-of-life (EOL) outcomes for patients with advanced cancer. PATIENTS AND METHODS: We conducted a retrospective analysis telemedicine visits for patients with metastatic lung cancer conducted during the first surge of the COVID-19 pandemic (October 3, 2020-October 6, 2020). We used natural language processing (NLP) to characterize documentation of SIC domains (ie, goals of care [GOC], limitation of life-sustaining treatment [LLST], prognostic awareness [PA], palliative care [PC], and hospice). We used unadjusted logistic regression to evaluate factors associated with SIC documentation and the relationship between SIC documentation and EOL outcomes. RESULTS: The study included 634 telemedicine visits across 360 patients. Documentation of at least one SIC domain was present in 188 (29.7%) visits with GOC and PA being the most discussed domains. Family presence (odds ratio [OR], 1.66; P = .004), progressive or newly diagnosed disease (OR, 5.42; P

BACKGROUND: Non-pharmacological interventions, as complements to pharmacological treatments, are widely employed for managing symptom clusters in patients with lung cancer. Although numerous systematic reviews and meta-analyses have explored the effects of these interventions, most studies have centred on the broader cancer population and specific symptom clusters. This review aims to consolidate existing non-pharmacological interventions and assess their effectiveness in managing symptom clusters among lung cancer patients. METHODS: A comprehensive literature search, encompassing eight databases from inception to October 1, 2024, was conducted. Two independent reviewers carried out the study selection, quality assessment, and data extraction. Methodological quality was evaluated using the Cochrane Risk-of-Bias 2 tool and the Risk of Bias in Non-randomized Studies of Interventions. The findings were synthesized narratively based on intervention type and supplemented by meta-analysis using RevMan 5.4 software. The study protocol was registered with PROSPERO (CRD42023467406). RESULTS: This systematic review comprised 15 relevant studies involving 1,692 patients, published between 2011 and 2024. The analysis revealed the effectiveness of psychological, educational, and complementary or alternative medicine interventions in alleviating the severity of most symptom clusters. However, the efficacy of exercise-based and multimodal interventions remained inconclusive. The meta-analysis demonstrated a positive impact of non-pharmacological interventions on depression compared with the control conditions (SMD = -0.30, 95% CI [-0.46, -0.15], p

BACKGROUND: Interleukin-18 (IL-18), or interferon (IFN)-γ-inducing factor, potentiates T helper 1 and natural killer cell activation as well as CD8+ T-cell proliferation. Recombinant IL-18 has displayed limited clinical efficacy in part due to the expression of the decoy receptor, IL-18 binding protein (IL-18BP). A series of IL-18 variants that are devoid of IL-18BP binding, termed DR18 (decoy-resistant IL-18), was developed via directed evolution. We tested DR18 using oncolytic adenovirus (oAd) as a platform for delivery in syngeneic mouse tumor models. METHODS: oAd harboring wild-type IL-18 or DR18 (oAdDR18) was constructed by inserting IL-18 mutant into modified oAd backbone with Ad5/3 chimeric fiber. The delivery effect and IFN-γ induction were determined by ELISA. The antitumor efficiency of oAdDR18 was tested in CT26, B16BL6 and 4T1 tumor-bearing mice, or athymic nude mice and compared with recombinant DR18 protein (rDR18). 4T1 lung metastasis model was used to evaluate the antitumor efficiency of local and distant tumors. Antitumor memory and synergistic effect with an anti-programmed cell death protein-1 (PD-1) antibody was evaluated. The phenotypes of the immune cells in tumor microenvironment were analyzed by flow cytometry and immunohistochemistry. RESULTS: Mice received oAdDR18 maintained stable production of IL-18 and IFN-γ compared with those received rDR18. Intratumoral delivery of oAdDR18 significantly reduced tumor growth across several tumor models, but not in the athymic nude mouse model. Mice that had tumor remission showed antitumor memory. The antitumor effect was associated with intratumor infiltration of CD4+ and CD8+ T cells. DR18 delivered by oAd demonstrated long-lasting and enhanced antitumor activities against local and distant tumors compared with that received rDR18 or wild-type IL-18 delivered by oAd (oAdwtIL-18). oAdDR18 treatment also reduced 4T1 lung metastasis. In addition, combination of this virotherapy with immune checkpoint inhibitors (ICIs)like the anti-PD-1 antibody further enhanced the antitumor activity as compared with respective monotherapy. CONCLUSIONS: oAdDR18 demonstrates enhanced antitumor activities through the induction of stronger local and system immunities and modulation of the tumor microenvironment compared with those of oAdwtIL-18 and rDR18. A combination of oncolytic virotherapy with cytokine engineering would lead to cytokine-based therapeutics for cancer and other diseases.

BACKGROUND: Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and COPD have high symptom burden, poor quality of life, and high health care use at the end of life. Although proactive integration of palliative care in lung cancer can improve outcomes, it is unclear whether similar practices have been adopted in COPD and IPF care. RESEARCH QUESTION: Do patients with COPD and IPF have different patterns of health care and palliative care use at the end of life compared with patients with lung cancer? STUDY DESIGN AND METHODS: We retrospectively identified deceased patients with lung cancer, COPD, or IPF with ≥ 1 outpatient visit at the University of California, San Francisco, in the last 6 months of life. We compared outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care use, and in-hospital death in the last 6 months of life between each group. We used multivariable logistic regression to calculate adjusted ORs (aORs) of each outcome, with lung cancer as the reference group. RESULTS: Among 1,819 patients, patients with COPD and IPF were more likely to be male and older at the time of death compared with patients with lung cancer. Compared with patients with lung cancer, patients with COPD and IPF showed a lower adjusted odds (P < .001) of receiving outpatient palliative care (COPD: aOR, 0.26 [95% CI, 0.19-0.36]; IPF: aOR, 0.48 [95% CI, 0.32-0.70]), outpatient opioid prescription (COPD: aOR, 0.50 [95% CI, 0.40-0.63]; IPF: aOR, 0.40 [95% CI, 0.29-0.54]), and a higher odds of end-of-life ICU use (COPD: aOR, 2.88 [95% CI, 2.11-3.93]; IPF: aOR, 4.15 [95% CI, 2.66-6.49]). Patients with IPF showed higher odds of receiving inpatient palliative care (aOR: 2.02 [95% CI, 1.30-3.13]; P = .002). INTERPRETATION: This study showed that patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and are more likely to use end-of-life intensive care than patients with lung cancer. Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and to align with patient goals of care.