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Background: Depression is prevalent among lung cancer patients undergoing chemotherapy, and the symptom cluster of fatigue-pain-insomnia may influence their depression. Identifying characteristics of patients with different depression trajectories can aid in developing more targeted interventions. This study aimed to identify the trajectories of depression and the fatigue-pain-insomnia symptom cluster, and to explore the predictive factors associated with the categories of depression trajectories. Methods: In this longitudinal study, 187 lung cancer patients who were undergoing chemotherapy were recruited and assessed at the first (T1), second(T2), and fourth(T3) months using the Patient Health Questionnaire-9 (PHQ-9), the Brief Pain Inventory (BPI), the Brief Fatigue Inventory (BFI), and the Athens Insomnia Scale (AIS). Growth Mixture Model (GMM) and Latent Class Analysis (LCA) were used to identify the different trajectories of the fatigue-pain-insomnia symptom cluster and depression. Binary logistic regression was utilized to analyze the predictive factors of different depressive trajectories. Results: GMM identified two depressive trajectories: a high decreasing depression trajectory (40.64%) and a low increasing depression trajectory (59.36%). LCA showed that 48.66% of patients were likely members of the high symptom cluster trajectory. Binary logistic regression analysis indicated that having a history of alcohol consumption, a higher symptom cluster burden, unemployed, and a lower monthly income predicted a high decreasing depression trajectory. Conclusions: Depression and fatigue-pain-insomnia symptom cluster in lung cancer chemotherapy patients exhibited two distinct trajectories. When managing depression in these patients, it is recommended to strengthen symptom management and pay particular attention to individuals with a history of alcohol consumption, unemployed, and a lower monthly income. [ABSTRACT FROM AUTHOR]

This study explores the effect of integrating Pender's Health Promotion Model with the concept of Enhanced Recovery After Surgery (ERAS) on postoperative health behaviors and rehabilitation outcomes in athletic lung cancer patients. Methods: A total of 98 athletic patients with lung cancer admitted to Wuhu Hospital, affiliated with East China Normal University, between January 2023 and June 2023, were randomly divided into an observation group (Group A) and a control group (Group B). The control group (n=49) underwent thoracoscopic lobectomy and received postoperative care under the ERAS nursing model. The observation group (n=49) was additionally introduced to Pender's Health Promotion Model, with a focus on enhancing physical activity and overall health behaviors. The study compared treatment outcomes, postoperative recovery, and health education satisfaction between the two groups. Results: The observation group demonstrated significantly higher scores in role function, physical function, and social function compared to the control group (P < 0.05). Furthermore, the observation group showed a significantly lower total incidence of complications, reduced oxygen inhalation time, and shorter hospital stays (P < 0.05). Health education satisfaction was also higher in the observation group than in the control group (P < 0.05). Conclusions: The integration of Pender's Health Promotion Model with the ERAS concept effectively enhances the development of healthy behaviors, reduces postoperative complications, and improves surgical treatment outcomes in athletic lung cancer patients. [ABSTRACT FROM AUTHOR]

Background: Cost-utility analysis generally requires valid preference-based measures (PBMs) to assess the utility of patient health. While generic PBMs are widely used, disease-specific PBMs may capture additional aspects of health relevant for certain patient populations. This study investigates the construct and concurrent criterion validity of the cancer-specific European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 dimensions (QLU-C10D) in non-small-cell lung cancer patients. Methods: We retrospectively analysed data from four multicentre LUX-Lung trials, all of which had administered the EORTC Quality of Life Questionnaire (QLQ-C30) and the EQ-5D-3L. We applied six country-specific value sets (Australia, Canada, Italy, the Netherlands, Poland, and the United Kingdom) to both instruments. Criterion validity was assessed via correlations between the instruments' utility scores. Correlations of divergent and convergent domains and Bland-Altman plots investigated construct validity. Floor and ceiling effects were assessed. Results: The comparison of the EORTC QLU-C10D and EQ-5D-3L produced homogenous results for five of the six country tariffs. High correlations of utilities (r > 0.7) were found for all country tariffs except for the Netherlands. Moderate to high correlations of converging domain pairs (r from 0.472 to 0.718) were found with few exceptions, such as the Social Functioning–Usual Activities domain pair (max. r = 0.376). For all but the Dutch tariff, the EORTC QLU-C10D produced consistently lower utility values compared to the EQ-5D-3L (x̄ difference from − 0.082 to 0.033). Floor and ceiling effects were consistently lower for the EORTC QLU-C10D (max. 4.67% for utilities). Conclusions: The six country tariffs showed good psychometric properties for the EORTC QLU-C10D in lung cancer patients. Criterion and construct validity was established. The QLU-C10D showed superior measurement precision towards the upper and lower end of the scale compared to the EQ-5D-3L, which is important when cost-utility analysis seeks to measure health change across the severity spectrum. [ABSTRACT FROM AUTHOR]

Abstract Background Depression is prevalent among lung cancer patients undergoing chemotherapy, and the symptom cluster of fatigue-pain-insomnia may influence their depression. Identifying characteristics of patients with different depression trajectories can aid in developing more targeted interventions. This study aimed to identify the trajectories of depression and the fatigue-pain-insomnia symptom cluster, and to explore the predictive factors associated with the categories of depression trajectories. Methods In this longitudinal study, 187 lung cancer patients who were undergoing chemotherapy were recruited and assessed at the first (T1), second(T2), and fourth(T3) months using the Patient Health Questionnaire-9 (PHQ-9), the Brief Pain Inventory (BPI), the Brief Fatigue Inventory (BFI), and the Athens Insomnia Scale (AIS). Growth Mixture Model (GMM) and Latent Class Analysis (LCA) were used to identify the different trajectories of the fatigue-pain-insomnia symptom cluster and depression. Binary logistic regression was utilized to analyze the predictive factors of different depressive trajectories. Results GMM identified two depressive trajectories: a high decreasing depression trajectory (40.64%) and a low increasing depression trajectory (59.36%). LCA showed that 48.66% of patients were likely members of the high symptom cluster trajectory. Binary logistic regression analysis indicated that having a history of alcohol consumption, a higher symptom cluster burden, unemployed, and a lower monthly income predicted a high decreasing depression trajectory. Conclusions Depression and fatigue-pain-insomnia symptom cluster in lung cancer chemotherapy patients exhibited two distinct trajectories. When managing depression in these patients, it is recommended to strengthen symptom management and pay particular attention to individuals with a history of alcohol consumption, unemployed, and a lower monthly income.

Background: The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis. Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of the likelihood of such metastasis, thereby providing clinicians with crucial information to enhance diagnostic precision and ultimately improve patient survival and prognosis Methods: In total, 623 eligible patients were recruited from two medical institutions. Seven deep learning models, namely Alex, GoogLeNet, Resnet18, Resnet101, Vgg16, Vgg19, and MobileNetv3 (small), were utilized to extract deep image histological features. The dimensionality of the extracted features was then reduced using the Spearman correlation coefficient (r ≥ 0.9) and Least Absolute Shrinkage and Selection Operator. Eleven machine learning methods, namely Support Vector Machine, K-nearest neighbor, Random Forest, Extra Trees, XGBoost, LightGBM, Naive Bayes, AdaBoost, Gradient Boosting Decision Tree, Linear Regression, and Multilayer Perceptron, were employed to construct classification prediction models for the filtered final features. The diagnostic performances of the models were assessed using various metrics, including accuracy, area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value. Calibration and decision-curve analyses were also performed. Results: The present study demonstrated that using deep radiomic features extracted from Vgg16, in conjunction with a prediction model constructed via a linear regression algorithm, effectively distinguished the status of mediastinal lymph nodes in patients with lung cancer. The performance of the model was evaluated based on various metrics, including accuracy, area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value, which yielded values of 0.808, 0.834, 0.851, 0.745, 0.829, and 0.776, respectively. The validation set of the model was assessed using clinical decision curves, calibration curves, and confusion matrices, which collectively demonstrated the model's stability and accuracy Conclusion: In this study, information on the deep radiomics of Vgg16 was obtained from computed tomography images, and the linear regression method was able to accurately diagnose mediastinal lymph node metastases in patients with lung cancer.

Background: For patients with lung cancer, timely identification of new lung lesions as infectious or noninfectious, and accurate identification of pathogens is very important in improving OS of patients. As a new auxiliary examination, metagenomic next-generation sequencing (mNGS) is believed to be more accurate in diagnosing infectious diseases in patients without underlying diseases, compared with conventional microbial tests (CMTs). We designed this study to find out whether mNGS has better performance in distinguishing infectious and non-infectious diseases in lung cancer patients using bronchoalveolar lavage fluid (BALF). Materials and Methods: This study was a real-world retrospective review based on electronic medical records of lung cancer patients with bronchoalveolar lavage (BAL) and BALF commercial mNGS testing as part of clinical care from 1 April 2019 through 30 April 2022 at The First Affiliated Hospital of Sun Yat-sen University. 164 patients were included in this study. Patients were categorized into the pulmonary non-infectious disease (PNID) group (n = 64) and the pulmonary infectious disease (PID) group (n = 100) groups based on final diagnoses. Results: BALF mNGS increased the sensitivity rate by 60% compared to CMTs (81% vs. 21%, p < 0.05), whereas there was no significant difference in specificity (75% vs. 98.4%, p > 0.1). Among the patients with PID, bacteria were the most common cause of infection. Fungal infections occurred in 32% of patients, and Pneumocystis Yersini was most common. Patients with Tyrosine kinase inhibitors (TKIs) therapy possess longer overall survival (OS) than other anti-cancer agents, the difference between TKIs and immuno-checkpoint inhibitors (ICIs) was insignificant (median OS TKIs vs. ICIs vs. Anti-angiogenic vs. Chemo vs. Radiotherapy = 76 vs. 84 vs. 61 vs. 58 vs. 60). Conclusions: our study indicates that BALF mNGS can add value by improving overall sensitivity in lung cancer patients with potential pulmonary infection, and was outstanding in identifying Pneumocystis infection. It could be able to help physicians adjust the follow-up treatment to avoid the abuse of antibiotics. [ABSTRACT FROM AUTHOR]

Objective • This study investigated the expression and clinical significance of Melanoma Associated Antigen (MAGE)-A proteins and mRNA in patients with nonsmall cell lung cancer (NSCLC). Methods • A retrospective study was conducted, and we selected a cohort of 88 NSCLC patients treated at our hospital from January 2015 to January 2020. Adjacent tissues were chosen as controls. The expression of MAGE-A proteins in lung cancer and adjacent tissues was assessed via Western blot, while MAGE-As mRNA expression was measured using RT-PCR. Results • The relative expression levels of MAGE-A proteins and mRNA in NSCLC tissues were significantly higher than those in adjacent tissues (P < .05), with values of (0.343 ± 0.101) and (0.728 ± 0.112), respectively. Furthermore, MAGE-As protein expression was significantly higher in stage III - IV lung cancer compared to stage I - II (P < .05). No significant differences were observed in MAGE-A protein expression concerning gender, age, tumor diameter, pathological type, and differentiation degree (P > .05). The relative expression of MAGE-As mRNA was significantly higher in clinical stage III - IV and moderately differentiated lung cancer tissues compared to stage I - II and well-differentiated tissues (P < .05). No significant differences were found in MAGE-As mRNA expression concerning gender, age, tumor diameter, and pathological type (P > .05). Patients with high MAGE-As mRNA expression had a significantly shorter median overall survival of 33 months (95% CI: 31.64-34.36) compared to those with low MAGE-As mRNA expression (P < .05). However, no significant difference was observed in median overall survival between patients with high and low MAGE-As protein expression (P > .05). Conclusions • In NSCLC, the up-regulation of MAGE-A proteins and mRNA is associated with clinical stage and differentiation degree, warranting further investigation. [ABSTRACT FROM AUTHOR]

Objective • Lung cancer patients mostly had different degrees of impaired pulmonary function, and these damage also significantly affect quality of life. The concept of pulmonary rehabilitation applicable to patients with chronic respiratory diseases is also applicable to patients with lung cancer. The current application of pulmonary rehabilitation for lung cancer is inconsistent, and reliable guidelines are lacking. The purpose of this study was to investigate the effect of pulmonary rehabilitation exercise based on wearable device pedometer on lung cancer patients with impaired pulmonary function, and to find a suitable pulmonary rehabilitation program for patients with lung cancer. Methods • In this retrospective study, 100 lung cancer patients with impaired pulmonary function were included. Among them, 51 patients received pulmonary rehabilitation exercise based on a wearable device pedometer (Experiemental group), while 49 received routine nursing mode (Control group). The respiratory function, quality of life, and sports endurance of the two groups were observed. Results • The incidence of postoperative atelectasis, pulmonary infection, hypoxemia, postoperative oxygen therapy time, chest tube indwelling time, and postoperative hospital stay in the experimental group were significantly lower than those in the control group (P < .05); The FEV1, FVC and FVE1% of the experimental group were significantly higher than those of the control group after intervention (all P < .05). Conclusion • Pulmonary rehabilitation exercise based on a wearable device pedometer can effectively improve the respiratory function and exercise endurance of lung cancer patients with impaired pulmonary function and can improve the quality of life and reduce the length of hospital stay. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the impact of mind–body exercise (yoga, tai chi, qigong, etc.) on lung cancer. Methods: We performed a literature search of the electronic databases PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, WanFang Data, and VIP from their inception to 16 May 2023. The primary outcome was the 6-min walk test (6MWT), while the secondary outcomes were anxiety levels and quality of life (QoL). Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias (ROB) tool for randomized controlled trials, with differences agreed by consensus. Meta-analysis was performed using RevMan 5.4 and Stata 15 software to analyze the extracted data. Results: This meta-analysis included a total of 11 studies involving 897 patients. The results indicated that compared to the usual care group, lung cancer patients in the mind–body exercise group could increase the 6-min walk distance (5 studies, 346 participants, WMD: 18.83, 95% CI (7.55, 30.10) P = 0.001), reduce anxiety levels (4 studies, 362 participants, SMD: − 1.51, 95% CI (− 1.74, − 1.27), P < 0.05), and enhance the overall quality of life (6 studies, 594 participants, SMD: 0.71, 95% CI (0.10, 1.31), P = 0.02). The overall certainty of the evidence for all outcomes was low; seven studies were judged to be at low risk of bias, and four studies were judged to be at moderate risk of bias. Conclusion: Mind–body exercise could improve exercise capacity in lung cancer survivors, reduce anxiety, and positively affect overall quality of life. PROSPERO registration number: CRD42023426800 [ABSTRACT FROM AUTHOR]

Background: Lung cancer continues to be the leading cause of cancer‑related deaths in men and women. A breakdown by level of economic development shows no differences in cancer deaths in men but a higher rate of lung cancer deaths in women in industrialized countries as compared with developing nations. The risk factors for lung cancer most commonly include lifestyle, environmental, and occupational exposures. The role these factors play varies depending on geographic location, sex and race characteristics, genetic predisposition, as well as their synergistic interactions. Materials and Methods: It was a hospital‑based registry, wherein hospitals were selected from three zones-north, central, and south zones of Kerala. The study was registered with clinical trial registry of India with Registration No. CTRI/2021/02/031299. Registry of lung cancer patients was prepared at all sites and institutional ethical clearance was received from all sites. All patients with primary lung cancer, histologically proven of all age groups were included in the study. Results: A total of 761 patients were registered from six teaching hospitals in Kerala who were diagnosed with primary lung cancer during the period 2017–2019. The mean age of the study population was 65.1 ± 10.2 years. Of all, 81.1% of them were males and 18.9% were females. Histologically, 56.4% had adenocarcinoma and 25.6% had squamous cell carcinoma. Conclusion: It was observed that the proportion of females diagnosed with primary lung cancer is increasing. Patients get diagnosed at a later stage of the disease, which calls for screening and early detection of lung cancer. As it accounts for the highest mortality among all other cancers, there is high scope for prevention and screening strategies. [ABSTRACT FROM AUTHOR]

Background: Immune agents targeting Programmed cell death-1 (PD-1) are a new type of cancer treatment drugs. By inhibiting the interaction between PD-1 and PD-L1, the ability of the immune system to attack tumor cells is enhanced. These immune preparations have shown significant efficacy in the treatment of various malignant tumors. However, like other drugs, immune preparations targeting PD-1 may also cause side effects, including arthralgia. Therefore, we conduct a meta-analysis to assess whether immune-checkpoint inhibitors targeting programmed cell death-1 in lung cancer patients will lead to arthralgia adverse events. Methods: We conducted a comprehensive search across multiple databases, including PubMed, Medline (Ovid), Web of Science, Cochrane, Embase, Scopus, CKNI, Wang fang, VIP database, Sino Med, and Clinical Trails, to identify relevant studies. The search encompassed articles published up until June 20th, 2023. The primary outcome is adverse events about arthralgia and secondary outcomes are any other related with arthralgia. Data extraction was carried out by two independent individuals, and the Cochrane Risk of Bias tool version 2.0 was employed to assess the included studies. The systematic review and metaanalysis were conducted using RevMan 5.3 software. Results: 12 studies are included in the meta-analysis. All included studies were determined to have a low risk of random sequence generation bias. The meta-analysis result showed that arthralgia RR = 1.11, 95% CI [0.88, 1.40], I2 = 56%, back pain RR = 1.86, 95% CI [1.07, 3.26], I2 = 84%, myalgia RR = 0.49, 95% CI [0.27, 0.88], I2 = 86% and muscular pain RR = 1.97, 95% CI [1.40, 2.77], I2 = 23%. Conclusion: The use of targeted inhibitors may lead to an increased incidence of back pain, while potentially reducing the occurrence of myalgia. On the other hand, immune-checkpoint inhibitors targeting programmed cell death-1 in lung cancer patients may not cause arthralgia and muscular pain. [ABSTRACT FROM AUTHOR]

Lung cancer kills hundreds of thousands of people worldwide each year. Sites of immune cell activity called germinal centers (GCs) in lymph nodes are associated with improved survival outcomes in cancer patients. The mechanisms by which GCs influence patient survival are not well-understood but could hold the key to further improving survival. Our goal was to investigate the differences in the physical and cellular characteristics of healthy and cancer-reactive GCs to help elucidate the role of GCs in patients' response to cancer. To do so, GCs in a lung cancer-draining mediastinal lymph node were compared to GCs in a non-cancerous tonsil. We used multiplexed immunohistochemistry for 22 antibody targets to analyze the samples, thereby allowing simultaneous analysis of multiple biomarkers in a tissue sample. Although most cell types were present in similar proportions in the GCs of each tissue, there were more CD8+ T cells and follicular helper CD4+ T cells in the GCs of the cancerdraining node. A better understanding of the role of these cell types may lead to improved outcomes for lung cancer patients. [ABSTRACT FROM AUTHOR]

Background: Lung Cancer is a deadly disease which has negative outcomes affecting physical and mental health of the patient in different perspectives. It is the leading cause of death among males. Lung Cancer is commonly associated with smoking. Patient experience different events during the disease and treatment phase which not only disturb the patient but also affect the family members in the same way. Objective: This study aims to explore the challenges of Lung Cancer patients and strategies to cope up with the disease process. Design: Exploratory phenomenological descriptive study design Setting: Two major Public Sector Hospitals of Lahore; 1) Mayo Hospital 2) Jinnah Hospital Participants: Total 12 participants of Lung Cancer Diseases getting treatment since last 6 months were included in the study. Method: One to one in depth interviews were conducted with 12 participants, including males and females both, using purposive sampling technique. Self-structured Interview guide was used for the interviews leading with probing questions from the responses. Interviews were recorded and field notes were maintained to keep a record of the data for thematic analysis. Results: Stressors and Coping Strategies were the major themes emerged from the thematic analysis. To overcome the stressors, patients reported, they use belief system to cope up. Conclusion: Adaptability with the situation is a difficult task. Lung Cancer patients have many stressors which can only be overcome using confidence in inner self and having belief in Allah. Family members do play an important part to overcome the situation. [ABSTRACT FROM AUTHOR]

Background: Lung cancer continues to be the leading cause of cancer-related deaths in men and women. A breakdown by level of economic development shows no differences in cancer deaths in men but a higher rate of lung cancer deaths in women in industrialized countries as compared with developing nations. The risk factors for lung cancer most commonly include lifestyle, environmental, and occupational exposures. The role these factors play varies depending on geographic location, sex and race characteristics, genetic predisposition, as well as their synergistic interactions. Materials and Methods: It was a hospital-based registry, wherein hospitals were selected from three zones—north, central, and south zones of Kerala. The study was registered with clinical trial registry of India with Registration No. CTRI/2021/02/031299. Registry of lung cancer patients was prepared at all sites and institutional ethical clearance was received from all sites. All patients with primary lung cancer, histologically proven of all age groups were included in the study. Results: A total of 761 patients were registered from six teaching hospitals in Kerala who were diagnosed with primary lung cancer during the period 2017–2019. The mean age of the study population was 65.1 ± 10.2 years. Of all, 81.1% of them were males and 18.9% were females. Histologically, 56.4% had adenocarcinoma and 25.6% had squamous cell carcinoma. Conclusion: It was observed that the proportion of females diagnosed with primary lung cancer is increasing. Patients get diagnosed at a later stage of the disease, which calls for screening and early detection of lung cancer. As it accounts for the highest mortality among all other cancers, there is high scope for prevention and screening strategies.

To assess the economic burden of different chemotherapies for lung cancer patients and influencing factors in China. The economic burden of lung cancer, including direct, indirect and intangible costs was measured within three months after diagnosis and treatment. Direct cost included the cost of hospitalization, outpatient visits, out-of-pocket drug purchases, costs of transportation, accommodation and meal expenses while seeking treatments in hospitals. Cost information was attained from questionnaire and patients' medical record. Indirect cost was measured by the patients' and their caregivers' productive days lost due to outpatient visits and hospitalization for lung cancer treatment. Intangible cost was obtained through the willingness-to-pay method from a questionnaire completed by the patient. Among the total cost of CNY71,401.92, direct cost, indirect cost and intangible cost constituted 89.02%, 4.29%, and 6.69% respectively. Educational level, occupation, family income, lung cancer classification, and the city of residence significantly influenced the total cost. Limitations in our study included: First, our follow-up period of three months was relatively short compared to the whole survival period of lung cancer patients. Second, the sample size of the chemotherapy combined with targeted therapy group was not large enough, and the cost data obtained would need confirmation in future studies. Third, participants came from only two localities, which may somewhat limit the representativeness of the study results for the whole of China. The economic burden of lung cancer treatment mainly came from the cost of the drugs. Patients taking chemotherapy had significantly higher cost compared to patients using targeted therapy. The cost was generally higher for those with higher educational level, those with higher family income, and those living in an economically more developed city. Patients with NSCLC had higher cost compared to patients with SCLC. In China, lung cancer is the leading cause of cancer-related deaths and imparts a heavy economic burden. Most lung cancer patients are treated with chemotherapeutic and/of targeted agents because they are usually diagnosed at an advanced stage (IIIB or IV). The use of targeted therapy has achieved high response rates, longer overall survival, and longer progression-free survival compared with conventional chemotherapies. Adverse reactions with targeted therapeutic agents are usually mild compared with conventional chemotherapy. However, targeted drugs for lung cancer are usually more expensive than conventional chemotherapeutic drugs. It should be noted that the adverse effects and toxicities caused by chemotherapeutic drugs are generally more serious compared to targeted drugs; therefore, a number of measures are needed to prevent or relieve these reactions clinically. This can increase the financial burden of lung cancer treatment. Does these two treatments have a different cost? Our results showed that educational level, occupation, family income, classification of lung cancer, and the city of residence significantly influenced the total cost. Patients taking chemotherapy had significantly higher cost compared to patients using targeted therapy. This result suggests that targeted therapy for lung cancer is a better choice than chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Lung cancer patients and caregivers suffer psychological side effects that encompass poorer treatment outcomes, and are associated with negative quality of life outcomes. Therefore, psychological screening and appropriate intervention of both patients and caregiver is an essential part of advanced cancer care. Aims and Objectives: To assess for psychological distress and its correlates in newly diagnosed lung cancer patients and their caregivers. Materials and Methods: It was a cross-sectional study conducted among 40 lung cancer patients and their caregivers. The patients and caregivers were administered psychological questionnaire, and their psychological attributes were thus studied. Normality of quantitative data was checked by measures of Kolmogorov Smirnov tests. Comparisons for two groups were made by t-test. Proportions were compared using Chi-square or Fisher's exact test whichever applicable. Results: Twenty nine patients (72.5%) and twenty five caregivers (62.5%) had GHQ>=3 (P value=0.34). Nineteen patients (47.5%) and twenty one caregivers (52.5%) were diagnosed as having psychiatric diagnosis (P value=0.65). Sex, educational level, residence, and monthly income did not have any significant association with the psychological comorbidities. The other psychiatric scales used had a significant correlation with the results of GHQ and psychiatric morbidity (P value=0.00). Conclusions: Psychological comorbidities are found in lung cancer patients and their caregivers to a significant extent. The treating physicians should screen lung cancer patients and their caregivers for psychological comorbidities and manage them adequately.

Background: Lung cancer patients and caregivers suffer psychological side effects that encompass poorer treatment outcomes, and are associated with negative quality of life outcomes. Therefore, psychological screening and appropriate intervention of both patients and caregiver is an essential part of advanced cancer care. Aims and Objectives: To assess for psychological distress and its correlates in newly diagnosed lung cancer patients and their caregivers. Materials and Methods: It was a cross-sectional study conducted among 40 lung cancer patients and their caregivers. The patients and caregivers were administered psychological questionnaire, and their psychological attributes were thus studied. Normality of quantitative data was checked by measures of Kolmogorov Smirnov tests. Comparisons for two groups were made by t-test. Proportions were compared using Chisquare or Fisher's exact test whichever applicable. Results: Twenty nine patients (72.5%) and twenty five caregivers (62.5%) had GHQ>=3 (P value=0.34). Nineteen patients (47.5%) and twenty one caregivers (52.5%) were diagnosed as having psychiatric diagnosis (P value=0.65). Sex, educational level, residence, and monthly income did not have any significant association with the psychological comorbidities. The other psychiatric scales used had a significant correlation with the results of GHQ and psychiatric morbidity (P value=0.00). Conclusions: Psychological comorbidities are found in lung cancer patients and their caregivers to a significant extent. The treating physicians should screen lung cancer patients and their caregivers for psychological comorbidities and manage them adequately. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the effects of transcutaneous acupoint electric stimulation (TAES) and gastric electrical stimulation (GES) on cancer patients with chemotherapy-induced gastrointestinal (GI) symptoms. Methods: A total of 122 lung cancer patients receiving chemotherapy were assigned randomly to the following two groups: control group (usual care group, n = 61) and intervention group (TAES plus GES, n = 61). TAES involved two acupoints such as Neiguan (PC6) and Zusanli (ST36). GES was performed at gastric pacing sites on the body surface such as the places of projection of gastric antrum and corpus on the body surface. GES was performed on these sites for 14 days continuously (25 min every time, once daily). The effects of TAES and GES on GI symptoms were assessed using the Memorial Symptom Assessment Scale on the day prior to chemotherapy (time point 1) and days 14 (time point 2) and 28 (time point 3) after chemotherapy. Results: No significant differences in the demographic and disease-related variables were detected between the two groups. Differences in symptom occurrence and severity at time point 1 were not statistically significant between the two groups (both P > 0.05). At time points 2 and 3, GI symptoms such as loss of appetite, nausea, vomiting, diarrhea, and constipation in the stimulation group had statistically significantly improved compared with the control group (all P < 0.05). Conclusions: TAES and GES were efficacious in relieving GI discomfort in lung cancer patients after chemotherapy. TAES combined with GES is a safe and easy-to-use tool to manage GI symptoms in practice.

Objectives: Phosphatase and tensin homolog (PTEN) is a major tumor suppressor gene and is involved in cell survival control. PTEN loss of expression (PTEN-) is associated with a poor outcome. Our study investigated the prevalence of PTEN- in terms of its characteristics and disease prognosis for lung cancer patients. Materials and Methods: In total, 167 tissue blocks from lung cancer patients at Chareonkrung Pracharak Hospital between January 2010 and December 2020 were studied through immunohistochemistry staining (IHC) for PTEN expression. The clinicopathological factors, IHC features, and epidermal growth factor receptor (EGFR) status were analyzed in association with PTEN- in term of prognosis and the overall survival (OS). Result: Adenocarcinoma was the major subtype (85.6%) and most patients (90.6%) were diagnosed at stage IV of lung cancer. The prevalence of PTEN- was 66.5%. A location at the left lower lobe (LLL) location and the absence of tumor-infiltrating lymphocytes (TILs) were significantly associated with PTEN- (p=0.039, p=0.046), while the smoking was likely correlated but not statistically significant (p=0.09). The median OS for PTEN- was not significantly different from PTEN+ (8.88 vs 7.20 months, p=0.38). However, smoking, Eastern cooperative oncology group (ECOG) status and primary symptoms were significantly associated with poorer OS. Conclusion: The prevalence of PTEN- was higher in our studies. Absent TILs and a LLL location were independent factors associated with PTEN-. However, a right upper lobe (RUL) location with PTEN- tended to have a poor prognosis. Interestingly, better survival was found in active smokers with PTEN-. Further survival studies in cases with no TILs lesions and active smokers in associations PTEN expression and other immune-related biomarkers, such as programmed death-ligand 1 (PD-L1), are warranted. [ABSTRACT FROM AUTHOR]

This study aimed to quantitatively clarify the baseline drift for each respiratory cycle in two respiratory-gating methods using the intra-beam respiratory motion data of lung cancer patients. The residual motion and dose distribution were calculated based on intra-beam respiratory motion data with the baseline drift. To quantify the baseline drift |$\Delta$| during irradiation, it was defined as the inclination between the detected expiration point and the expiration point in the next cycle in the anterior–posterior (AP), cranial–caudal (CC) and left–right (LR) directions obtained using an in-house programme. The baseline drift value reached up to 0.74 mm/s in the CC direction as per the respiratory motion data of 10 patients. The homogeneity index (HI) of the phase-gating method tended to increase because the target was irradiated even when the amplitude position of the target differed from period to period. In contrast, the amplitude-gating method enabled irradiation considering the amplitude position of the target because the gating window was set considering the amplitude position of the respiratory motion. The respiratory-gating methods and respiratory phase in respiratory-gating lung stereotactic body radiation therapy (SBRT) must be determined based on the respiratory motion of the patients. [ABSTRACT FROM AUTHOR]

Background/Aim: A considerable number of patients with lung cancer are scheduled for definitive or adjuvant radiotherapy. Prevalence and potential risk factors of preradiotherapy sleep disturbances were evaluated. Patients and Methods: Nineteen factors were retrospectively investigated for associations with pre-radiotherapy sleep disturbances in 77 lung cancer patients. Factors included COVID-19 pandemic; age; gender; performance score; comorbidity index; history of another malignancy; distress score; number of emotional, physical or practical problems; patient’s request for psychological support; histology; tumor stage; upfront surgery; chemotherapy; and type of radiotherapy. Results: Thirty-one patients (40.3%) reported sleep disturbances that were significantly associated with distress score 6-10 (p=0.019), ≥2 emotional problems (p=0.001), ≥5 physical problems (p<0.001), and request for psychological support (p=0.006). Trends were found for female gender (p=0.064) and stereotactic body radiation therapy (p=0.057). Conclusion: Many lung cancer patients assigned to radiotherapy reported sleep disturbances. Risk factors can be used to identify patients in need of psychological support already before treatment. [ABSTRACT FROM AUTHOR]

Introduction: Well-balanced communication between healthcare professionals and oncology patients is the first step toward goals of caring for patients. Aims: In constant aim to improve patient outcomes, we aspired to uncover shortcomings in communication between healthcare professionals and patients suffering from lung cancer. An online survey of a non-probabilistic sample of cancer patients from twelve countries of Central and Eastern Europe designed and implemented by the Croatian Coalition of Associations in Healthcare. Methods: 472 lung cancer subjects were selected from the sample of results from 2,460 Croatian participants in the study from Oct. 2018. to Feb. 2019. Participants' sociodemographic and clinical characteristics, experience and communication with healthcare professionals, key areas of inefficiency, psychological and social support were assessed. The analysis included descriptive statistics and chi square to assess demographic differences. Results: The study revealed four main results: (i) only a minority of the participants were satisfied with the communication process, (ii) majority were not told that they could bring family member during delivering bad news, (iii) there was a clear unmet need to have a discussion on the impact of cancer on day to day activities (iv) participants' preferences indicate that the greatest improvement would be to perform all services at one place. Conclusions: This study revealed that one of the leading problems in oncology care according to patients is the lack of education and effective communication. Based on the obtained data, we conclude that there is a large space for improvement in patient experience and communication. [ABSTRACT FROM AUTHOR]

Background Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival. Methods Searches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for publications dated from January 1, 2000, to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival [OS], cancer-specific survival [CSS]) between NHW and Hispanic lung cancer patients. Results A final sample of 29 full-text articles were included, with 28 fully adjusted models of OS and 21 of CSS included. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (OS = 16, CSS = 11) or a Hispanic survival advantage (OS = 10, CSS = 9). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, and 2 studies of exclusively no-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics. Conclusions Hispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer. [ABSTRACT FROM AUTHOR]

Background: Local sequence context is known to have an impact on the mutational pattern seen in cancer. The RAS genes and a smoking carcinogen, Benzo[a]pyrene diol epoxide (BPDE), have been utilised to explore these context effects. BPDE is known to form an adduct at the guanines in a number of RAS gene sites, KRAS codons 12, 13 and 14, NRAS codon 12, and HRAS codons 12 and 14. Results: Molecular modelling techniques, along with multivariate analysis, have been utilised to determine the sequence influenced differences between BPDE-adducted RAS gene sequences as well as the local distortion caused by the adducts. Conclusions: We conclude that G:C > T:A mutations at KRAS codon 12 in the tumours of lung cancer patients (who smoke), proposed to be predominantly caused by BPDE, are due to the effect of the interaction methyl group at the C5 position of the thymine base in the KRAS sequence with the BPDE carcinogen investigated causing increased distortion. We further suggest methylated cytosine would have a similar effect, showing the importance of methylation in cancer development. [ABSTRACT FROM AUTHOR]

The screening of non-small cell lung cancer (NSCLC) tumors for anaplastic lymphoma receptor tyrosine kinase (ALK) gene rearrangements is important because of the dramatically favorable therapy response to ALK inhibitor. However, the exact mechanism of poor survival in ALK fusion lung cancer patients without receiving targeted therapy is unclear. In this study, total of 521 tumor specimens from Chinese patients with lung cancer were screened for ALK fusion by immunohistochemistry (IHC) and confirmed by fluorescence in situ hybridization (FISH). As results, there were no cases of coexisting EGFR and ALK mutations identified. Fourteen cases (2.7%) harbored ALK fusion, including eight solid adenocarcinomas with signet ring cell features, four acinar adenocarcinomas with cribriform pattern containing mucin, one adenosquamous carcinoma and one micropapillary adenocarcinoma with mucin. Six (42.9%) of fourteen patients with ALK-positive lung cancer had stage IV disease, and five ALK-positive patients treated with platinum-based chemotherapy had poor outcome (all patients were dead and the mean survival time was 12 months), compared to 72 months for patients with ALK inhibitor therapy. Furthermore, Five ALK-positive cases were analyzed by whole exome sequencing (WES) and via direct transcript counting using a digital probe-base (NanoString) to explore the driver genes. Deregulation of PI3K/AKT signaling pathway in ALK-positive lung cancer was demonstrated by WES analysis, and significantly increased mRNA of ALK, ROS1, MET, SPP1 and PI3K signaling pathway was identified by NanoString assay. The concordance between NanoString, IHC and FISH methodologies for detecting ALK fusion was 100%. Significant overexpression of SPP1 protein in ALK-positive lung cancer was confirmed by IHC compared to paired adjacent normal tissues and ALK-negative cancers. Thus we concluded that SPP1 overexpression is associated with poor outcomes for patients with ALK fusion lung cancer without receiving targeted therapy and PI3K/AKT/SPP1 pathway may become the promising targets in patients with aggressive lung cancer. [ABSTRACT FROM AUTHOR]

Background/Aim: The Covid-19 epidemic has severely strained health care systems across the globe. The impacts are multiple especially for patients cared for cancer. The Covid-19 epidemic has several impacts on the management of lung cancer patients. The aim of this work was to summarize the available epidemiological data on patients diagnosed with lung cancer infected with Covid-19 and describe the different strategies to improve the management of these patients by summarizing the recommendations in this area. Patients and Methods: The Teravolt cohort is an observational multicenter registry, including patients with non-small cell cancer, small cell cancer or mesothelioma but also epithelial tumors and a diagnosis of Covid-19. The Theravolt registry indicates an unexpectedly high mortality rate in patients with thoracic malignancies with COVID-19. Results: Between March 26 and April 12, 2020, 200 patients treated in 8 countries were included. They had a performance status (PS) of 0-1 in 72% of cases, were smokers or ex-smokers in 81% of cases, had non-small cell cancer (76% of cases), were under treatment in 74% of cases, and the majority were first-line cases (57%). The hospitalization rate was 76% and the mortality rate 33%; only 10% of patients with criteria for intensive care hospitalization were admitted to the intensive care. Conclusion: Data presented in this registry suggest a high mortality in patients with thoracic cancer and Covid-19. Therofere, the importance to create a safe healthcare system during Covid-19 pandemic is underlined along with the need for essential effective clinical service delivery to patients with lung cancer. [ABSTRACT FROM AUTHOR]

Background: Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival. Patients and Methods: The medical records of 439 lung cancer patients at a regional cancer center were reviewed and categorized according to treatment: (i) surgery; ii) radical radiotherapy; iii) stereotactic radiotherapy; iv) palliative treatment, no cancer symptoms; v) palliative treatment with severe cancer symptoms). Results: Proportions receiving timely treatment varied significantly at 39%, 48%, 10%, 44% and 89%, respectively (p<0.001). Overall, those starting treatment on time had the shortest median overall survival (10.6 vs. 22.6 months; p<0.001). This was also the case for palliative (5.3 vs. 11.4 months) (p<0.001) but not for curative treatment (not reached vs. 38.3 months) (p=0.038). Conclusion: Timely treatment is not necessarily associated with improved survival. [ABSTRACT FROM AUTHOR]

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Pleural effusion is a rare immune-related adverse event for lung cancer patients receiving immune checkpoint inhibitors (ICIs). We enrolled 281 lung cancer patients treated with ICIs and 17 were analyzed. We categorized the formation of pleural effusion into 3 patterns: type 1, rapid and massive; type 2, slow and indolent; and type 3, with disease progression. CD4/CD8 ratio of 1.93 was selected as the cutoff threshold to predict survival. Most patients of types 1 and 2 effusions possessed pleural effusion with CD4/CD8 ratios ≥ 1.93. The median OS time in type 1, 2, and 3 patients were not reached, 24.8, and 2.6 months, respectively. The median PFS time in type 1, 2, and 3 patients were 35.5, 30.2, and 1.4 months, respectively. The median OS for the group with pleural effusion CD4/CD8 ≥ 1.93 and < 1.93 were not reached and 2.6 months. The median PFS of those with pleural effusion CD4/CD8 ≥ 1.93 and < 1.93 were 18.4 and 1.2 months. In conclusion, patients with type 1 and 2 effusion patterns had better survival than those with type 3. Type 1 might be interpreted as pseudoprogression of malignant pleural effusion. CD4/CD8 ratio ≥ 1.93 in pleural effusion is a good predicting factor for PFS. [ABSTRACT FROM AUTHOR]

Lung squamous cell carcinoma (LUSC) is a common type of lung cancer with high incidence and mortality rate. Tumor mutational burden (TMB) is an emerging biomarker for selecting patients with non-small cell lung cancer (NSCLC) for immunotherapy. This study aimed to reveal TMB involved in the mechanisms of LUSC and develop a model to predict the overall survival of LUSC patients. The information of patients with LUSC were obtained from the cancer genome atlas database (TCGA). Differentially expressed genes (DEGs) between low- and the high-TMB groups were identified and taken as nodes for the protein–protein interaction (PPI) network construction. Gene oncology (GO) enrichment analysis and gene set enrichment analysis (GSEA) were used to investigate the potential molecular mechanism. Then, we identified the factors affecting the prognosis of LUSC through cox analysis, and developed a risk score signature. Kaplan–Meier method was conducted to analyze the difference in survival between the high- and low-risk groups. We constructed a nomogram based on the risk score model and clinical characteristics to predict the overall survival of patients with LUSC. Finally, the signature and nomogram were further validated by using the gene expression data downloaded from the Gene Expression Omnibus (GEO) database. 30 DEGs between high- and low-TMB groups were identified. PPI analysis identified CD22, TLR10, PIGR and SELE as the hub genes. Cox analysis indicated that FAM107A, IGLL1, SELE and T stage were independent prognostic factors of LUSC. Low-risk scores group lived longer than that of patients with high-risk scores in LUSC. Finally, we built a nomogram that integrated the clinical characteristics (TMN stage, age, gender) with the three-gene signature to predict the survival probability of LUSC patients. Further verification in the GEO dataset. TMB might contribute to the pathogenesis of LUSC. TMB-associated genes can be used to develope a model to predict the OS of lung squamous cell carcinoma patients. [ABSTRACT FROM AUTHOR]

Background: Little is known about 'within-patient delay', which is the time from first symptom of lung cancer to contacting primary care. Aim: Primary outcomes were length of within-patient delay and the proportion of total delay it represents. Secondary outcomes were factors causing delay and survival. Design & setting: A cohort study of newly diagnosed patients with lung cancer at two hospitals in Norfolk. Method: Patients completed questionnaires regarding onset of symptoms, whether they had delayed, and their reasons. GPs completed correlating questionnaires. Pathway times and other data were extracted from cancer registry and hospital records, and outcomes obtained prospectively. Factors causing delay were compared using ratios of geometric means. Results: In 379 patients, mean within-patient delay and pre-secondary care delay were 188.6 days and 241 days (61.4% and 78.5% of total delay, respectively). It was found that 38.8% of patients felt they had delayed. Patient-related causes of delay were denial (ratio of means [ROM] = 4.36; P = 0.002, 95% confidence interval [CI] = 1.71 to 11.1); anxiety (ROM = 3.36; P = 0.026; 95% CI = 1.16 to 9.76); non-recognition of symptoms (ROM = 2.80; P = 0.004; 95% CI = 1.41 to 5.59); and smoking (ROM = 1.76; P = 0.021; 95% CI = 1.09 to 2.86), respectively. These symptoms were associated with delay: finger swelling or discomfort (ROM = 2.72; P = 0.009, 95% CI = 1.29 to 5.74); cough (ROM = 2.53; P<0.001; 95% CI = 1.52 to 4.19); weight loss (ROM = 2.41; P<0.001; 95% CI = 1.49 to 3.88); weakness (ROM = 2.35; P = 0.001; 95% CI = 1.45 to 3.83); dyspnoea (ROM = 2.30; P = 0.001; 95% CI = 1.40 to 3.80); voice change (ROM = 1.90; P = 0.010; 95% CI = 1.17 to 3.10); and sputum (ROM = 1.66; P = 0.039; 95% CI = 1.03 to 2.67), respectively, also having more than five symptoms (compared with 1–3) (ROM = 3.69; P<0.001; 95% CI = 2.05 to 6.64). No overall relation between within-patient delay and survival was seen. Conclusion: Using smoking registers, awareness literature, and self-care manuals, primary care staff could liaise with people who have ever smoked regarding their symptoms to ensure early referral to secondary care. [ABSTRACT FROM AUTHOR]

Background: The incidence of catastrophic expenditure due to health-care costs is growing and is estimated to be one of the major contributors to poverty. The need to pay out-of-pocket can also mean that households do not seek care when they need it. The total economic burden of cancer therapy amounts to the mean of 36,812 Indian National Rupee (INR). Out of this, 40% comprises expenditure incurred before coming to the hospital. Objectives: This study assessed the total out-of-pocket expenditure (OOPE) of lung cancer patients before they seek services for treatment at a tertiary care center. Materials and Methods: This was an institution-based cross-sectional survey in newly diagnosed and registered lung cancer patients > 18 years old. Self-designed, pretested, semi-structured questionnaire for sociodemographic details and direct costs incurred under various subsets was used. Data were analyzed using Epi Info version 7.2.0.1. Results: Out of 91 patients registered, 73 (80.2%) were male. The median OOPE was 19000 INR (range: 8000–40,000). We found that the total mean expenditure (19,516.48 ± 6488.22) was almost ten times their per capita income (2012.444 ± 1283.09). The total mean direct medical costs incurred were 8974.73 ± 5252 INR and direct nonmedical costs incurred were 10,574.73 ± 4414 INR. This study further showed that the direct nonmedical costs incurred were significantly higher (P = 0.02) than the direct medical costs. Similarly, the costs incurred on diagnostics were significantly higher (P < 0.001) as compared to the cost incurred on medicines. Conclusion: Lung cancer patients face the burden of OOPE at every stage, starting from the initial visit to a local health facility till the final diagnosis and treatment at a tertiary health-care facility. More measures are warranted to curtail preregistration and pretreatment expenses such as preventing people from traveling long distances just for imaging and diagnostic facilities and hence curtailing nonmedical cataclysmic expenditure.

Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies such as lung cancer. Cutaneous reactions to checkpoint inhibitors are frequent, appearing in approximately 40% of patients. Although most of the reactions are well tolerated, these drugs can lead to severe cutaneous adverse reactions, but a quick recognition of the symptoms can significantly decrease their mortality. In this case report, we describe a patient with metastatic squamous lung cell carcinoma suffering from nivolumab-induced Stevens-Johnson syndrome with severe skin denudation and mucosal involvement. [ABSTRACT FROM AUTHOR]

Nailfold capillary abnormalities are typically observed in patients with systemic sclerosis and are also often found in patients with polymyositis (PM) and dermatomyositis (DM). Nailfold capillary abnormalities in some patients with PM/DM were found to improve with immunosuppressant treatment. However, the short-term changes in nailfold capillaries and their associations with disease activity have not been established yet. Additionally, there have been no reports on whether nailfold capillary abnormalities can change during the progression of malignant tumours. A man in his 60s with anti-transcriptional intermediate factor 1γ (anti-TIF-1γ) antibody-positive DM complicated with small cell lung carcinoma was treated with prednisolone (PSL) 70 mg, carboplatin (CBDCA) and etoposide (VP-16). His nailfold capillary abnormalities improved rapidly, and the tumour size decreased with treatment. Although chemotherapy was continued, abnormalities in the nailfold capillaries gradually recurred. The worsening of the capillary abnormalities prompted us to examine computed tomography scans, which showed the recurrence of lung cancer. After switching to second-line chemotherapy, the change in the nailfold capillary abnormalities was again in a parallel course with the disease status of lung cancer. Changes in nailfold capillaries may be useful not only for the diagnosis but also for the evaluation of the recurrence of malignant tumours with DM. [ABSTRACT FROM AUTHOR]

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions: The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay. [ABSTRACT FROM AUTHOR]

Lung cancer is the most commonly occurring cancer in men and the third most commonly occurring cancer in women. Contrary to other cancers, lung cancer often occurs in patients with comorbidities that can prevent the realisation of some treatments. The recommended treatment for patients presenting with stage I non-small cell lung cancer (NSCLC) is an anatomical surgical resection-lobectomy- and a systematic lymph node dissection. Many patients are, however, unfit to undergo surgery and consequently they often do not receive any curative therapy. This involves the elderly patients or patients with many co-morbidities. When an elderly patient with co-morbidities comes to the thoracic surgeon with early-stage lung cancer, if he is healthy and in good general condition he is taken to the operating room and undergoes lobectomy and lymph node dissection. If he is vulnerable and appropriate treatment is considered high risk he is treated with alternative therapies. SBRT is important alternative therapy. Stereotactic body radiation therapy (SBRT), interchangeably known as stereotactic ablative radiotherapy (SABR) is a modality that delivers ablative doses of radiation to extra-cranial targets with a degree of precision and accuracy above what can be reasonably achieved with conventionally fractionated external beam radiotherapy. Additionally, SBRT as a noninvasive therapy offers an attractive option for patients who are opposed to a surgical option. But questions have arisen regarding the suitability of SBRT for medically operable patients. Data from new trials are needed more than ever to inform and guide our multidisciplinary decisions for patients with earlystage NSCLC who are fit enough to undergo lung cancer surgery but may instead be more interestedin SBRT. In any case, good cooperation between surgeons and radiotherapists is of particular importance for the better treatment of these vulnerable patients. [ABSTRACT FROM AUTHOR]

Lung cancer (LC) is one of the most common types of cancer disease worldwide. Studies in the field show that the appearance of a pathology of this form causes changes not only in the patient's life, namely psychological problems, functional limitations and poorer health due to the clinical consequences of treatments, but also in their family, where caregivers often face the challenge of providing long-term daily care that induces a physical, psychosocial and financial burden (Borges et al., 2017; Hewitt et al., 2003; Tan et al., 2018). The main objective of the present study is to compare and relate the two groups (patients and caregivers) considering the quality of life (QoL) and symptoms of psychological distress (anxiety and depression). The total sample consisted of 30 patient/caregiver dyads. The instruments used were: Hospital Anxiety and Depression Scale; European Organization for Research and Treatment of Quality of Life Questionnaire (EORTC QLQ C-30) and its specific module for lung cancer (LC13); Caregiver Oncology Quality of Life Questionnaire (CarGOQoL) and Zarit Burden Interview Scale (ZBI). The results suggest the influence of depressive symptomatology on patients' QoL [F(1)=6.390; p<0.05] and depressive and anxious symptomatology and burden on caregivers' QoL [F(3)=7.815; p<0.001]. A positive association was found between depressive symptomatology of patients and caregivers (r=0.458; p=0.011) and differences in anxious symptomatology were also observed, with a higher result in the patient's group. [ABSTRACT FROM AUTHOR]

ObjectivesTo identify subgroups of patients with lung cancer receiving chemotherapy based on the severity dimension of symptom experience, and to examine changes in membership between these subgroups over time.MethodsPatients who were scheduled to receive chemotherapy completed the Chinese version of the MD Anderson Symptom Inventory and the revised lung cancer module with a total of 19 symptom items. Data were collected at three time points: two weeks before chemotherapy (T1), after chemotherapy cycle 1 (T2), and after chemotherapy cycle 3 or above (T3). The latent profile analysis and latent transition analysis were used to identify underlying subgroups and describe changes in subgroup membership over time.ResultsFrom the total sample (N = 195), 160 patients completed the symptom assessment at T1, T2, and T3. Two distinct latent symptom profiles of patients could be identified at T1, T2, and T3, which were classified as “Mild” and “Moderate-Severe” profiles. From T1 to T2 and T3, members in the Mild profile were more likely to move to the Moderate-Severe profile. Chemotherapy protocols, prior surgery treatment, and level of education can predict the transitions.ConclusionResults provide a better understanding of the patient’s different symptom experiences and characteristics. These could help clinicians to anticipate symptom patterns and develop interventions in lung cancer patients who were scheduled to receive chemotherapy for the first time.

Objectives: To identify subgroups of patients with lung cancer receiving chemotherapy based on the severity dimension of symptom experience, and to examine changes in membership between these subgroups over time. Methods: Patients who were scheduled to receive chemotherapy completed the Chinese version of the MD Anderson Symptom Inventory and the revised lung cancer module with a total of 19 symptom items. Data were collected at three time points: two weeks before chemotherapy (T1), after chemotherapy cycle 1 (T2), and after chemotherapy cycle 3 or above (T3). The latent profile analysis and latent transition analysis were used to identify underlying subgroups and describe changes in subgroup membership over time. Results: From the total sample (N = 195), 160 patients completed the symptom assessment at T1, T2, and T3. Two distinct latent symptom profiles of patients could be identified at T1, T2, and T3, which were classified as "Mild" and "Moderate-Severe" profiles. From T1 to T2 and T3, members in the Mild profile were more likely to move to the Moderate-Severe profile. Chemotherapy protocols, prior surgery treatment, and level of education can predict the transitions. Conclusion: Results provide a better understanding of the patient's different symptom experiences and characteristics. These could help clinicians to anticipate symptom patterns and develop interventions in lung cancer patients who were scheduled to receive chemotherapy for the first time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of astragalus polysaccharides (APS) on bone marrow suppression and hematopoietic stem cells during chemotherapy in elderly patients with lung cancer. Methods: 120 elderly patients with lung cancer treated in the first hospital of Xingtai city from January 2019 to early December 2019 were divided into the treatment group and the control group by the random number table method, all of whom received pemetrexed + carboplatin chemotherapy, and the treatment group was treated with APS at the same time. The efficacy was evaluated after 2 cycles of chemotherapy, bone marrow suppression was observed, and levels of TCM symptoms score, peripheral blood T lymphocyte subgroup index, L-selectin (CD62L) and macrophage differentiation antigen-1 (Mac-1) were measured before and after 2 cycles of chemotherapy. Results: The response rate (RR) was 56.67% in the treatment group and 45.00% in the control group, with no statistically significant difference (P > 0.05); The disease control rate (DCR) in the treatment group was 81.67%, which was significantly higher than 65.00% in the control group (P < 0.05); The reduction degree of leukopenia in the treatment group was significantly lower than that in the control group (P < 0.05); The treatment group had a platelet reduction of grade 1 + 2 at a rate of 40.00%, and hemoglobin reduction of grade 1 + 2 at a rate of 28.33%, which were significantly lower than the control group at 65.00% and 58.33% (P < 0.05); Compared with those before chemotherapy, the total score of TCM symptoms, serum CD62L and Mac-1 levels in the two groups all decreased significantly after chemotherapy, and they were significantly lower in the treatment group than in the control group (P < 0.05); After chemotherapy, CD3+, CD4+ and CD4+/CD8+ in the treatment group increased significantly and they were all higher in the treatment group than in the control group, while CD8+ decreased significantly and was lower in the treatment group than in the control group (P < 0.05). There was no statistically significant difference in T lymphocyte subsets before and after chemotherapy in the control group (P>0.05). Conclusion: Astragalus polysaccharide can improve the chemotherapy effect and improve the bone marrow suppression in elderly patients with lung cancer, which may be related to its obvious enhancement of immune function and decrease of CD62L and Mac-1 levels. [ABSTRACT FROM AUTHOR]

Objectives: Dossiers submitted for early benefit assessments in Germany also provide information on the precise determination of the target population (patients eligible for a drug). The situation is complex for non-small-cell lung cancer (NSCLC) due to highly specific therapeutic indications. Our aim was to compare the different methodological steps applied to determine the target population in dossiers on drugs for NSCLC. Methods: We analysed NSCLC dossiers assessed by the German Institute for Quality and Efficiency in Health Care (IQWiG) between 01.01.2011 and 31.12.2017. Methodological details regarding the determination of the target population were extracted and compared. Results: We analysed 23 NSCLC dossiers. In all dossiers, the target population was determined using the number of all patients with lung cancer as the basis for calculations. This patient population was further reduced in several successive steps by assuming proportions of patients with a specific characteristic (e.g. disease stage). The most important calculation steps were patients with NSCLC (n = 23 dossiers), with a specific disease stage (n = 23), with a specific tumour mutation (n = 14), with a specific tumour histology (n = 7), without prior treatment (n = 15), with pretreatment in second or further treatment lines (n = 17), and/or with specific pretreatments (n = 9). The proportions of patients determined within the same calculation step varied considerably between dossiers. Discussion: The calculation methods applied and the target population sizes reported in NSCLC dossiers vary considerably. A consensus with regard to the databases and calculation methods used to determine the target population in NSCLC would be helpful to reduce variations. [ABSTRACT FROM AUTHOR]

Hand-crafted radiomics has been used for developing models in order to predict time-to-event clinical outcomes in patients with lung cancer. Hand-crafted features, however, are pre-defined and extracted without taking the desired target into account. Furthermore, accurate segmentation of the tumor is required for development of a reliable predictive model, which may be objective and a time-consuming task. To address these drawbacks, we propose a deep learning-based radiomics model for the time-to-event outcome prediction, referred to as DRTOP that takes raw images as inputs, and calculates the image-based risk of death or recurrence, for each patient. Our experiments on an in-house dataset of 132 lung cancer patients show that the obtained image-based risks are significant predictors of the time-to-event outcomes. Computed Tomography (CT)-based features are predictors of the overall survival (OS), with the hazard ratio (HR) of 1.35, distant control (DC), with HR of 1.06, and local control (LC), with HR of 2.66. The Positron Emission Tomography (PET)-based features are predictors of OS and recurrence free survival (RFS), with hazard ratios of 1.67 and 1.18, respectively. The concordance indices of 68 % , 63 % , and 64 % for predicting the OS, DC, and RFS show that the deep learning-based radiomics model is as accurate or better in predicting predefined clinical outcomes compared to hand-crafted radiomics, with concordance indices of 51 % , 64 % , and 47 % , for predicting the OS, DC, and RFS, respectively. Deep learning-based radiomics has the potential to offer complimentary predictive information in the personalized management of lung cancer patients. [ABSTRACT FROM AUTHOR]

With the increasing incidence rate of lung cancer patients, early diagnosis could help in reducing the mortality rate. However, accurate recognition of cancerous lesions is immensely challenging owing to factors such as low contrast variation, heterogeneity and visual similarity between benign and malignant nodules. Deep learning techniques have been very effective in performing natural image segmentation with robustness to previously unseen situations, reasonable scale invariance and the ability to detect even minute differences. However, they usually fail to learn domain‐specific features due to the limited amount of available data and domain agnostic nature of these techniques. This work presents an ensemble framework Deep3DSCan for lung cancer segmentation and classification. The deep 3D segmentation network generates the 3D volume of interest from computed tomography scans of patients. The deep features and handcrafted descriptors are extracted using a fine‐tuned residual network and morphological techniques, respectively. Finally, the fused features are used for cancer classification. The experiments were conducted on the publicly available LUNA16 dataset. For the segmentation, the authors achieved an accuracy of 0.927, significant improvement over the template matching technique, which had achieved an accuracy of 0.927. For the detection, previous state‐of‐the‐art is 0.866, while ours is 0.883. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical effect of preventive nursing intervention on deep venous thrombosis rate, nursing satisfaction and average hospitalization time after treatment of lung cancer. Methods: Chinese databases (Wanfang, Weipu and China Knowledge Network) and English databases (Pubmed, Cochrane and Scopus) were searched and read references for relevant research. Statistical analysis was performed using Review Manager 5.3. The odds ratio (OR) and the mean difference (MD) were used as the combined effect values of the comparison groups. Sensitivity analysis was performed by changing the effect model or excluding the literature with a large weight ratio, and the symmetry of the funnel plot was observed for publication bias test. Results: A total of 14 Chinese studies included. Compared with routine nursing intervention, preventive nursing intervention could significantly reduce the rate of deep vein thrombosis after lung cancer treatment [OR=0.16 (0.10, 0.23)], improve nursing satisfaction [OR=6.42 (3.32, 12.41)] and shorten the average hospital stay [MD=-7.41 (-8.16, - 6.65)], without heterogeneous existing. And regardless of whether the lung cancer patient was undergoing resection or chemotherapy, the effect of preventive nursing intervention to reduce the rate of deep vein thrombosis was very significant. Conclusion: Preventive nursing intervention is beneficial to patients with lung cancer, which can significantly reduce the formation rate of deep vein thrombosis, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]