Hyperglycemia and prostate cancer recurrence in men treated for localized prostate cancer.

Background:Obesity is consistently linked with prostate cancer (PCa) recurrence and mortality, though the mechanism is unknown. Impaired glucose regulation, which is common among obese individuals, has been hypothesized as a potential mechanism for PCa tumor growth. In this study, we explore the relationship between serum glucose at time of treatment and risk of PCa recurrence following initial therapy.Methods:The study group comprised 1734 men treated with radical prostatectomy (RP) or radiation therapy (RT) for localized PCa between 2001-2010. Serum glucose levels closest to date of diagnosis were determined. PCa recurrence was determined based on PSA progression (nadir PSA+2 for RT; PSA0.2 for RP) or secondary therapy. Multivariate Cox regression was performed to determine whether glucose level was associated with biochemical recurrence after adjusting for age, race, body mass index, comorbidity, diagnosis of diabetes, Gleason Sum, PSA, treatment and treatment year.Results:Recurrence was identified in 16% of men over a mean follow-up period of 41 months (range 1-121 months). Those with elevated glucose (100 mg/dl) had a 50% increased risk of recurrence (HR 1.5, 95% CI: 1.1-2.0) compared with those with a normal glucose level (<100 mg/dl). This effect was seen in both those undergoing RP (HR 1.9, 95% CI: 1.0-3.6) and those treated with RT (HR 1.4, 95% CI: 1.0-2.0).Conclusions:Glucose levels at the time of PCa diagnosis are an independent predictor of PCa recurrence for men undergoing treatment for localized disease

Using Natural Language Processing to Identify Health Plan Beneficiaries With Pulmonary Nodules

Background/Aims: The development of a portable, automated method for identifying individuals with lung nodules will facilitate the efficient conduct of population-based studies of nodule care and associated outcomes. We evaluated the performance of a previously developed natural language processing (NLP) algorithm for identifying health plan beneficiaries with pulmonary nodules. Methods: A cross-sectional study was performed of 500 randomly selected adult, in-network health plan beneficiaries with continuous enrollment at Group Health Cooperative who underwent a computed tomography (CT) of the chest in 2012, had no history of lung cancer and had not undergone a CT between 2009 and 2011. An NLP algorithm originally developed at Kaiser Permanente Southern California assessed electronic radiology reports using keywords and qualifiers relating to pulmonary nodules ranging in size from 5 to 30 mm among individuals who had undergone CT and had an International Classification of Diseases (ICD-9-CM) diagnostic code for a lung nodule. This algorithm was applied to our patient population and modified to identify pulmonary nodules regardless of size. A trained chart abstractor reviewed radiology reports to determine whether the radiologist reported a lung nodule. An experienced, board-certified thoracic surgeon adjudicated radiology reports with unclear documentation of a nodule. Results: The true prevalence of pulmonary nodules among individuals undergoing CT in 2012 — median age 65 years, 43% men, 84% white, 51% smokers — was 34%. Median nodule size was 6 mm (range 2–87 mm). NLP identified 218 (44%) individuals with a nodule. The accuracy of NLP was as follows: sensitivity 91%, specificity 81%, positive predictive value 72% and negative predictive value 95%. Discussion: An automated method of using NLP and electronic radiology text reports — originally developed at one Cancer Research Network (CRN) site — reasonably identifies health plan members with pulmonary nodules at another CRN site. This finding supports the notion that automated methods are portable across integrated health systems and institutions using electronic medical records. Ongoing work seeks to determine whether modifications to the NLP algorithm can improve performance. Given its current performance characterized by a high negative predictive value, NLP could be used to decrease the burden of chart abstraction in population-based studies of nodule care

I Already Know that Smoking ain\u27t Good for Me : Patient and Clinician Perspectives on Lung Cancer Screening Decision-Making Discussions as a Teachable Moment

Background Lung cancer screening (LCS) is now recommended for people at high risk of dying from lung cancer. The purpose of this study is to use the LCS decision discussion as a case study to understand possible underlying components of a teachable moment to enhance motivation for smoking cessation. Methods We investigated how patients and clinicians communicate about smoking by performing in-depth, semi-structured interviews of the experiences of 51 individuals who formerly or currently smoked offered LCS, and 24 clinicians. We discuss the baseline interviews only since including the follow-up interviews would be beyond the scope of this manuscript. Interviews focused on communication about smoking, the perceived importance of discussing smoking and screening together, and patients’ perceived challenges to smoking cessation. Results Patients and clinicians differed in their views on the role of the LCS decision discussion as a teachable moment. While clinicians felt that this discussion was a good opportunity to positively influence smoking behaviors, neither patients nor clinicians perceived the discussion as a teachable moment impacting smoking behaviors. We found there are other motivating factors for smoking cessation. Conclusions Our findings indicate that LCS decision discussions are not a teachable moment for behavior change in smoking cessation now, but perhaps clinicians could address other aspects of communication to enhance motivation for cessation. Our hypothesized teachable moment model helps explain there may not be sufficient emotional response elicited during the discussion to motivate a major behavior change like smoking cessation

A couples’ based self-management program for heart failure: Results of a feasibility study

Background: Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers. Objective: To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others. Methods: We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases. The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life. Results: Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and significant others declined over time. Conclusions: In this small pilot study, we showed positive trends with involving significant others in self-management. SUCCEED has the potential of addressing the growing public health problem of HF among patients who receive care from their significant other