Smoking: Taxing Health and Social Security

While the health risks associated with smoking are well known, the impact on income distributions is not. This paper extends the literature by examining the distributional effects of a behavioral choice, in this case smoking, on net marginal Social Security tax rates (NMSSTR). The results show that smokers, as a result of shorter life expectancies, incur a higher NMSSTR than nonsmokers. In addition, as low-earnings workers have a higher smoking prevalence than high-earnings workers, smoking works to widen the income distribution. This higher tax rate could have implications for both labor supply behavior and Social Security system funding

First author research productivity of United States radiation oncology residents: 2002-2007.

PURPOSE: Participation in investigative research is a required element of radiation oncology residency in the United States. Our purpose was to quantify the first author research productivity of recent U.S. radiation oncology residents during their residency training. METHODS AND MATERIALS: We performed a computer-based search of PubMed and a manual review of the proceedings of the annual meetings of the American Society for Therapeutic Radiology and Oncology to identify all publications and presented abstracts with a radiation oncology resident as the first author between 2002 and 2007. RESULTS: Of 1,098 residents trained at 81 programs, 50% published \u3e or =1 article (range, 0-9), and 53% presented \u3e or =1 abstract (range, 0-3) at an American Society for Therapeutic Radiology and Oncology annual meeting. The national average was 1.01 articles published and 1.09 abstracts presented per resident during 4 years of training. Of 678 articles published, 82% represented original research and 18% were review articles. Residents contributed 15% of all abstracts at American Society for Therapeutic Radiology and Oncology annual meetings, and the resident contribution to orally presented abstracts increased from 12% to 21% during the study period. Individuals training at programs with \u3e6 residents produced roughly twice as many articles and abstracts. Holman Research Pathway residents produced double the national average of articles and abstracts. CONCLUSION: Although variability exists among individuals and among training programs, U.S. radiation oncology residents routinely participate in investigative research suitable for publication or presentation at a scientific meeting. These data provide national research benchmarks that can assist current and future radiation oncology residents and training programs in their self-assessment and research planning

Do racial or socioeconomic disparities exist in lung cancer treatment?

Determine the effects of race, socioeconomic status, and treatment on outcomes for patients diagnosed with lung cancer. The Florida cancer registry and inpatient and ambulatory data were queried for patients diagnosed from 1998-2002. A total 76,086 of lung cancer patients were identified. Overall, 55.6% were male and 44.4% were female. The demographic distribution of patients was 92.7% Caucasian, 6.7% African American, and 5.7% Hispanic. The mean age of diagnosis was 70 years old. African American patients presented at a younger age, with more advanced disease, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 8.7 months, while MST for African American patients was 7.5 months. Patients who received surgery, chemotherapy, or radiation therapy demonstrated significantly improved outcomes. Stepwise multivariate analysis revealed that African American race was no longer a statistically significant predictor of worse outcomes once corrections were made for demographics and comorbid conditions, suggesting that the originally reported disparities in lung cancer outcomes and race may be in part because of poor pretreatment performance status. In contrast, patients of the lowest socioeconomic status continue to have a slightly worse overall prognosis than their affluent counterparts (hazard ratio = 1.05, P = .001). Lung cancer continues to carry a poor prognosis for all patients. Once comorbidities are corrected for, African American patients carry equivalently poor outcomes. Nonetheless, emphasis must be placed on improving pretreatment performance status among African American patients and efforts for earlier diagnosis among the impoverished patients must be made

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

Object The discovery of incidental low-grade gliomas (LGGs) on MR imaging is rare, and currently there is no existing protocol for management of these lesions. Various studies have approached the dilemma of managing patients with incidental LGGs. While some advocate surgery and radiotherapy, others reserve surgery until there is radiological evidence of growth. For neurosurgeons and radiologists, determining the course of action after routine brain imaging poses not only a medical but also an ethical dilemma. The authors conducted a systematic review of case reports and case series in hopes of enhancing the current understanding of the management options for these rare lesions. Methods A PubMed search was performed to include all relevant MR imaging studies in which management of suspected incidental LGG was reported. Comparisons were made between the surgical treatment arm and the active surveillance arm in terms of outcome, mode of discovery, reasons for treatment, and histology. Results Nine studies with 72 patients were included in this study (56 in the surgical arm and 16 in the active surveillance arm). Within the surgical arm, 49% remained deficit free after treatment, 25% showed evidence of tumor progression, 13% underwent a second treatment, and 7% died. The active surveillance group resulted in no unanticipated adverse events, with serial imaging revealing no tumor growth in all cases. Lesion regression was reported in 31% of this group. The surgical arm's mortality rate was 7% compared with 0% in the active surveillance arm. Conclusions Treatment decisions for incidental LGG should be individualized based on presenting symptoms and radiological evidence of growth. The asymptomatic patient may be monitored safely with serial MR imaging and occasionally PET scanning before treatment is initiated. In patients presenting with nonspecific symptoms or concurrent symptomatic lesions, treatment may be initiated earlier to reduce potential morbidity. All treatment decisions must be tempered by patient factors and expectations of anticipated benefit

Abstract A114: Does being Latino affect a patients outcome after being diagnosed with squamous cell carcinoma of the head and neck: An analysis of the SEER database

Abstract Purpose/Objective(s): Ethnicity, marital status, and socioeconomic status have all been associated with outcomes in head and neck cancer. However, how Hispanic ethnicity relates to outcome is a question that remain without an established answer. Here, we attempt to evaluate the differences within the US various ethnicity groups diagnosed with head and neck cancer. We specifically focused on the clinical outcomes of patients with Hispanic background. Material/Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to examine the clinical outcomes of patients with head and neck cancer by ethnicity, region of origin, place of birth, treatment modality (surgery, radiation or both), primary location (oral cavity, oral pharynx, hypopharynx or larynx), age, gender, and SEER tumor stage (in situ, local, regional, distant). We assembled a cohort of patients aged 21 years and older diagnosed from 1988 to 2002 and followed through 2006. The non-US born Hispanic populations were pooled for some analyses due to low numbers. A Cox proportional hazard model for overall survival was used. Results: We selected a cohort of 45,324 patients. Stage was distributed as: 4.2% in situ disease, 33.4% local, 52.5% regional involvement, and 9.9% had distant disease. Male patients composed 72.4% of the cohort. Age was broken down to under 50 yrs old (12.8%), 50-70 (55.9%) and over 70 (31.3%). Caucasians made up 75.7% of the cohort, Blacks 11.9%, Mexicans 1.7%, Cuban/Dominican 0.3%, Central American 0.3%, South American 0.3% and US-born Hispanic 9.8%. Treatment consisted of surgery in 34%, radiation 29.8% and combined modality in 36.2%. The primary site was oral cavity in 33.1 %, oropharynx 32%, hypopharynx 7.6%, and larynx 27.3%. On the multivariate analysis of the entire population: Age (1.026,1.025-1.027); female gender (0.947,0.923-0.972), race; white (ref.), Black (1.407, 1.361-1.454), non-US born Hispanic (0.742,0.684-0.804), US born Hispanic (0.857,0.823-0.892); stage: in situ (0.515,0.483-0.548), localized (0.598,0.582-0.615), regional (ref.), distant (1.718,1.656-1.781); site: oral cavity (1.294,1.253-1.336), oropharynx (ref.), hypopharynx (1.406,1.347-1.467), larynx (0.955,0.925-0.985), and treatment modality: surgery (0.951,0.922-0.981), radiotherapy (1.361, 1.325-1.398), and combined modality (ref). When only patients with regional disease were assessed, surgery and surgery +radiation were not significantly different. Patients with radiation therapy did worse (1.368,1.321-1.417). The results for ethnicity were similar for the whole group. By site, oral cavity (1.472,1.412-1.534), hypopharynx (1.492, 1.418-1.571), and larynx (1.101,1.057-1.147) all did worse than oropharynx (ref.). Conclusion: Ethnicity has been associated with clinical outcome in head and neck cancer in the past. Using the SEER database, we show that Hispanic population appears to have a better prognosis compared to their Caucasian peers while both do better than Blacks. This was observed across all stages and also in patients with regional disease. Furthermore, non-US born Hispanic did have the best prognosis followed by the US born Hispanic group. The cause of this disparity is unclear and warrants further investigation. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A114.</jats:p