Practice Patterns Of Genetic Testing And Target Therapy Use In Metastatic Lung Cancer

Introduction All patients with metastatic non-small cell lung cancer (NSCLC) should undergo EGFR mutation testing and receive appropriate therapy, however, variation in testing and therapy use is a growing concern. The objective of this investigation was to identify physicians’ practice patterns and predictors of physicians’ genetic testing and targeted therapy use in metastatic lung cancer. Methods Approximately 360 physicians caring for CanCORS patients with lung or colorectal cancer completed a survey between 2012 to 2013 assessing attitudes and practices with respect to genetic testing and targeted therapies. The outcome variables were: (1) physicians’ reports that they would likely recommend (a) EGFR testing and (b) ERCC1 testing for a hypothetical patient; (2) physicians’ reports that they would choose Erlotinib as first-line regimen if a patient was found to have an EGFR mutation. Results Physicians who often obtained information from peer-reviewed medical literature reported that they would recommend EGFR testing more than those who rarely/never used this source (p=0.068). Physicians who were younger, had fewer years since graduation from medical school, graduated from a U.S./Canadian school, and were Asian or White chose Erlotinib more than physicians without these features (p=0.008, p=0.011, p=0.068, and p=0.021). Physicians who reported local/national guidelines as having a high impact on their test use, and those who reported obtaining information often from local colleagues, national/international experts, or national guidelines, chose Erlotinib more than their counterparts (p=0.066, p=0.062, p=0.037, and p=0.041). Those with solo practice types were the least likely to recommend Erlotinib compared to other practice types (p=0.013). After adjustment, gender, age, race, practice type, impact of national guidelines, and obtaining information from national/international experts all remained significantly associated with choice of Erlotinib (OR[CI]=2.07 [1.12, 3.81] and OR[CI]=1.56 [0.96, 2.52], respectfully). Conclusion It can be inferred that the variation seen in testing and treatment in patients with NSCLC is largely due to the differences in physicians’ knowledge, which are the result of diverse sources of information. The implications that follow the findings of the present paper include: the importance of considering the content and format of reports and guidelines directed towards clinicians; and the need for easily accessible interfaces that provide the knowledge and support for clinical decision-making

Image Retrieval Using Dynamic Weighting of Compressed High Level Features Framework with LER Matrix

In this article, a fabulous method for database retrieval is proposed.  The multi-resolution modified wavelet transform for each of image is computed and the standard deviation and average are utilized as the textural features. Then, the proposed modified bit-based color histogram and edge detectors were utilized to define the high level features. A feedback-based dynamic weighting of shape, color and textural features composition produce a resistant feature vectors for image retrieval and recall. A comprehensive and unified matching scheme based on matrix error rate technique was accomplished for similarity of image and retrieval procedure. The feature vectors size in our algorithm is the least one evaluated to the different techniques. Furthermore, the calculation time of previously published techniques is much more than the presented algorithm which is a benefit in proposed retrieval method. The experimental results illustrates that novel algorithm obtains more precious in retrieval and the efficiency in evaluating with the other techniques and algorithms at Corel color image database

Factors Associated with Cancer Disparities among Low-, Medium-, and High-Income US Counties

Background: There are concerns about the degree to which county income level might underlie the stark disparities in cancer death rates among US counties; at the same time, there is uncertainty about the factors that may mediate the disparities.Objectives: To assess county-level cancer death rates and to identify possible mediators of the association between county-level median incomes and cancer death rates. Design, Setting, and Participants: Cross-sectional study using death records from the National Center for Health Statistics in 2014, with data collected and analyzed between October 1, 2016, and July 31, 2017. All US counties and county equivalents were included. Exposures: County-level median household income. Main Outcomes and Measures: County-level age-standardized cancer death rate. Results: In 3135 counties, median incomes ranged from 22126 US dollars to 121250 US dollars per year. Low-income counties (median income, 33445 US dollars) vs high-income counties (median income, 55780 US dollars) had higher proportions of residents who were non-Hispanic black, lived in rural areas, or reported poor or fair health. The mean (SD) cancer death rate was 185.9 (24.4) per 100000 person-years in high-income counties, compared with 204.9 (26.3) and 229.7 (32.9) per 100000 person-years in medium- and low-income counties, respectively. In mediation models, health risk behaviors (smoking, obesity, and physical inactivity); clinical care factors (unaffordable care and low-quality care); health environments (food insecurity); and health policies (state smoke-free laws and Medicaid payment rates) in aggregate accounted for more than 80% of the income-related disparity. The strongest possible mediators were food insecurity (explaining 19.1% [95% CI, 12.5%-26.5%] of the association between county incomes and cancer deaths), low-quality care (17.9%; 95% CI, 14.0%-21.8%), smoking (12.7%; 95% CI, 9.4%-15.6%), and physical inactivity (12.2%; 95% CI, 9.4%-15.6%). Conclusions and Relevance: There are wide gaps in cancer death rates between low-, medium-, and high-income counties. Future studies are needed to assess whether targeting the possible mediators might ameliorate the substantial socioeconomic cancer disparities.</p

Treatment patterns and survival in hepatocellular carcinoma in the United States and Taiwan.

BackgroundSurvival in hepatocellular carcinoma (HCC) is lower in the USA than in Taiwan. Little is known about the extent to which differences in stage at diagnosis and treatment contribute to this difference. We examined treatment patterns and survival in HCC and analyzed factors driving the difference.MethodsUsing a uniform methodology, we identified patients aged 66 years and older with newly diagnosed HCC between 2004 and 2011 in the USA and Taiwan. We compared treatment within 6 months after HCC diagnosis and 2-year stage-specific survival between the two countries.ResultsCompared with patients in Taiwan (n = 32,987), patients in the USA (n = 7,003) were less likely to be diagnosed as stage IA (4% vs 8%) and II (13% vs 22%), or receive cancer-directed treatments (41% vs 58%; all p ConclusionsDifferential stage at diagnosis and treatment were substantially associated with the survival difference, but approximately two-thirds of the difference remained unexplained. Identifying the main drivers of the difference could help improve HCC survival in the USA

Does cardiac rehabilitation improve patient emotional well-being and illness perception

Background: Exercise-based cardiac rehabilitation (CR) programs promote lifestyle modification to improve prognosis in patients with cardiovascular disease. However, the effect of CR on patients’ perceived emotional well-being and illness perception has not been fully studied. Methods and Results: Two arms were used in this study. Arm 1 enrolled new CR participants and Arm 2 enrolled existing CR participants. Three validated questionnaires were employed. ANOVA and Wilcoxon signed rank test were used to compare differences between the groups. A total of 238 patients were enrolled from July 1 to December 31, 2015 with 131 patients (55%) in Arm 1 and 107 (45%) in Arm 2. Statistically significant differences of illness perception were seen between the groups. Arm 1 patients had statistically significant improvements in illness perception, perceived emotional support, and depression after CR. Conclusions: CR participation is associated with improved illness perception, perceived emotional support, and decreased depression