Evaluating WHO, CCI, and CFS Performance in Predicting Non-small cell Lung Cancer Survival in Finland: Insights Beyond CONCORD-3

Background: Set against the backdrop of the 2018 CONCORD-3 study, our research focuses on Finland\u27s lung cancer survival rates. Despite similar tax-funded and public healthcare systems, these rates lag behind those of other Nordic countries, prompting an investigation into the underlying causes. This research aims to unravel these disparities, particularly in the context of Finland\u27s success in other cancer domains, contributing to broader efforts to elevate lung cancer outcomes to the level of other Nordic cancer success stories. Study objective: Our study focuses on evaluating clinical performance classification systems like WHO Score, Charlson Comorbidity Index (CCI), and Clinical Frailty Scale (CFS) for their predictive accuracy in NSCLC survival and treatment outcomes. We analyze the CCI\u27s weighted scoring of comorbidities and the CFS\u27s applicability in assessing elderly patients\u27 fitness or frailty. This research is integral to our broader aim of identifying key factors influencing lung cancer care in Finland. By integrating these systems into lung cancer treatment evaluations, we endeavor to improve care quality and decision-making in treatment strategies, thereby enhancing patient management effectiveness. Methods: For this study, we analyzed 2018 data on NSCLC patients from Finnish university and central hospitals. This is part of a larger project that includes all lung cancer histologies. Concurrently, we are compiling a 2021 cohort to assess recent advancements in lung cancer care, with a focus on the effectiveness of immunotherapy and personalized treatment modalities. This work is supported by ethical approval from Findata and includes a partnership with the Norwegian Cancer Registry for comparative analysis. Utilizing R, we conducted Kaplan-Meier and Cox regression analyses on a dataset of 427 variables, ensuring robust survival analysis and significance testing. Results: We found that the WHO Score remains the gold standard in clinical performance evaluation, demonstrating significant statistical differences between scores (pConclusions: Our study emphasizes the critical role of functional capacity assessments in lung cancer evaluations, highlighting the need for thorough validation. The underperformance of the CCI in our NSCLC cohort underscores the importance of expanding beyond traditional comorbidity indices. Particularly for the oncogeriatric population, our findings stress the value of individualized functional assessments, like WHO and CFS, in crafting effective, personalized treatment plans

A Translational Approach Towards More Cost-Effective Lung Cancer Treatments

Lung cancer, globally the second most common cancer, causes 1.8 million deaths annually with 2 million new cases. It\u27s also one of Finland\u27s deadliest cancers. Chemotherapeutic agents, targeted drugs and radiation therapy have been the mainstay in oncologic treatment for lung cancer patients for decades. Checkpoint inhibitors (e.g. nivolumab, pembrolizumab, atezolizumab) have changed the landscape also in lung cancer. These drugs awake patients own immune system to attack cancer cells. These drugs are widely used in different cancers and they have efficacy also in lung cancer, but only in a minority of patients. Checkpoint inhibitors also induce autoimmune side effects. Majority are mild, but often irreversible, such as hypothyroidism or diabetes. Life-threatening and fatal adverse events are rare, but they also occur. Neither treatment response nor adverse effects can be predicted individually. In Finland, these drugs cost app. 10 000€ per month per one patient increasing the economic burden to our society. Thus, we need better understanding of lung cancer biology to be able to offer individual therapies in patient-centered manner, but also within the limits of the carrying capacity of our society. In 10-15% of lung adenocarcinomas there is a driver EGFR-mutation. Checkpoint inhibitor are ineffective in this type. However, EGFR pathway targeted agents, such as osimertinib, deliver often sustainable responses, but unfortunately resistance mechanism arise in this subtype as well. We need to better understand also the resistance mechanism in EGFR mutated subtypes to better tailor the best optimal treatment sequences to our patients. Translational research, that combines the basic science of lung cancer biology with patient characteristics and treatment outcomes, is a crucial tool in responding to these demands. Tumor microenvironment plays an important role in carcinogenesis, as well as in treatment response, especially acidic environment is immunosuppressive and promotes cancer cell survival. Mucins are a large family of transmembrane glycoproteins expressed on epithelial membranes, including airways. They form the protective immunogenic glycocalyx against microbes as well as pollutants, e.g., carcinogens in tobacco smoke. They are involved in lung cancer formation and in drug resistance forming an important compartment of the tumor microenvironment protecting cancer cells from immune system. Mucins function also as a signaling platform orchestrating cell proliferation, migration and metastasis. Our hypothesis is that dysfunctional regulation and expression of mucin 13, a member of mucin family, provides an immunosuppressive environment and associates with poor response to checkpoint inhibition and poor survival. Mucin 13 is also involved in EGFR signaling. Analyzing mucin 13 with advanced biomolecular techniques using tumor and serum samples of Finnish lung cancer patients combined with clinical characteristics and treatment outcomes will elucidate the biological mechanisms and improve patient selection for optimal treatments

Kitaristina Uuden Iloisen Teatterin musiikki-ilottelussa 2009

Tämä opinnäytetyöni kirjallinen osuus on raportti ja prosessikuvaus työskentelystäni kitaristina Uuden Iloisen Teatterin produktiossa Kivat Piipussa keväällä 2009. Työni perustuu pääosin harjoituspäiväkirjaan, jota pidin koko harjoitusperiodin ajan. Työn tavoite oli tuoda esiin muusikon monipuolista ja haasteellista työnkuvaa kyseisessä viihteellisessä teatteriproduktiossa sekä kuvata työtapoja ja tilanteita, jotka mahdollisesti poikkeavat perinteisestä muusikkoudesta tai teatterimuusikkoudesta. Uudella Iloisella Teatterilla on takanaan pitkä ja merkittävä taival suomalaisessa viihteessä. Sen tekijät ovat alusta alkaen olleet suomalaisen viihteen kärkikastia. Siksi luodaan lyhyt katsaus Uuden Iloisen Teatterin historiaan ja tärkeisiin henkilöihin sen taustalla, sekä kuvataan niitä erityispiirteitä, jotka tekivät kyseisessä teatterissa työskentelystä muusikon kannalta mielenkiintoista ja haastavaa. Harjoitusjakson kuvaus jaetaan kahteen osaan harjoituspaikan ja harjoiteltujen asioiden perusteella. Alkuosuudessa keskitytään Uuden Iloisen Teatterin ilotteluissa perinteeksi muodostuneen orkesterinumeron tanssiharjoituksiin ja jälkimmäisessä osuudessa fokus on musiikissa. Työssä esitellään myös produktiossa käytetyt työvälineet sekä kerrotaan, millä perusteella kyseisiä instrumentteja, efektejä ja vahvistimia päädyttiin käyttämään. Tähän liittyen pohditaan myös hyvän monitorikuuntelun rakentamista ja siihen vaikuttaneita seikkoja tässä kyseisessä tapauksessa. Työssä pohditaan myös muusikon työtä ja etiikkaa laajemmin. Kysymys muusikoiden tavasta työskennellä sairaana kyseenalaistetaan, ja kerrotaan, mitä tähän liittyviä oivalluksia selkävaivojen kanssa kamppaileminen synnytti. Yksittäisen soittajan asemaa pohditaan myös osana kokonaisuutta. Oma kuulokuva ja tuntemukset saattavat poiketa yleisölle välittyvästä paljonkin. Niinpä sen oikeellisuutta pohditaan suhteessa kokonaisuuteen sekä muille välittyvään lopputulokseen. Työssä ei tuoda esille paljoakaan uutta tietoa muusikon työstä tai tehtävistä. Siinä kuitenkin mielestäni onnistuneesti kuvataan sitä monipuolista tehtäväkenttää, joka kyseisessä produktiossa soittajien eteen aukesi. Kautta linjan punaisena lankana toimii yksittäisen soittajan työskentely kokonaisuuden osana ja sen hyväksi.The written part of my thesis is a report and process description of my work as a guitarist in a revue show entitled Kivat Piipussa (an untranslatable pun). The review was produced by Uusi Iloinen Teatteri (The New Happy Theatre) in spring 2009. The primary aim of my study is to focus attention to the versatile and challenging role of a musician in this kind of entertaining theatrical performance. I also wanted to describe the methods and situations that possibly distinguish this type of musicianship from a musician's work in a more traditional performance setting in theatre or elsewhere. Uusi Iloinen Teatteri has a long and significant history of producing review shows. I introduce the important people behind its success and discuss what makes it so interesting and challenging for a musician to work with this theatre company. My study is primarily based on my rehearsal journal of spring 2009. Description of this period is divided into two parts on the basis of training place and what was being practised. At Uusi Iloinen Teatteri the band has traditionally performed a number of their own. The first part of the journal is a description of dance rehearsals of the show. The second part focuses on music. I also introduce the sound equipment I used and discuss the choices I made when setting up the stage monitor system for this particular production. When working at Uusi Iloinen Teatteri I gained a lot of insights into working as a musician. In my thesis, I discuss professional ethics. I question the musician's common practice to go to work sick and write about what I learned from struggling with an aching back. This study does not contain much new information about musician's work itself, but it meets its objective of giving a detailed account of the versatile role of an indiviual player in this particular production. The study looks at an individual musician's work as part of the whole and reviews his contribution to the process