Self-Reported Cardiovascular Disease and the Risk of Lung Cancer, the HUNT Study

Introduction:Inflammation is involved in development of lung cancer and cardiovascular disease (CVD), and we hypothesize that self-reported CVD is an independent risk factor for lung cancer.Methods:Data from the Nord-Trøndelag Health Study (1984–2008) linked to the Norwegian Cancer and Death Cause Registry were analyzed stratified by smoking status. In total, 97,087 persons (1,634,967 person years) were included (never smokers 567,575 person years, former smokers 295,685 person years, current smokers 444,922 person years, and unknown 326,785 person years) and followed for an average of 15 years. The proportional hazard model was applied to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for self-reported CVD on lung cancer incidence rate adjusted for age, sex, body mass index, burden of tobacco smoking and chronic cough with phlegm.Results:1080 cases of lung cancer (1.1%) occurred. A total of 5981 (6.9%) participants had at baseline or developed during follow-up self-reported CVD. After adjusting for confounders, self-reported CVD was an independent risk factor for the development of lung cancer in former (HR [95% CI] 1.74 [1.11–2.73]) and current smokers (HR [95% CI] 1.38 [1.04–1.83]), but not in never smokers (HR [95% CI] 0.87 [0.34–2.23]).Conclusions:Self-reported CVD was independently associated with increased occurrence of lung cancer in former and current smokers. CVD may be a novel risk factor for lung cancer screening

Prolonged Survival in Patients with Lung Cancer with Diabetes Mellitus

IntroductionPatients with lung cancer have a high frequency of comorbidity. Data on the impact of diabetes mellitus, the most frequent endocrine disorder, on the prognosis of lung cancer are conflicting. The aim was to investigate the impact of diabetes mellitus on survival in lung cancer.MethodWe analyzed data from a cohort, the Nord-Trøndelag Health Study (HUNT study) linked to the Norwegian Cancer Registry and controlled the results using two lung cancer studies, the Pemetrexed Gemcitabine study and the Norwegian Lung Cancer Biobank. Survival in lung cancer with and without diabetes mellitus was compared using the Kaplan-Meier method and Cox regression model for each study and the studies combined.ResultsOne thousand six hundred seventy-seven cases of lung cancer were included, 1031 from HUNT study, 436 from the Pemetrexed Gemcitabine study, and 210 from the Norwegian Lung Cancer Biobank registry, and among these 77 patients had diabetes mellitus. In the combined analysis, patients with lung cancer with diabetes mellitus had increased survival compared with those without (p = 0.005). The 1-, 2-, and 3-year survival in patients with lung cancer with and without diabetes mellitus were 43% versus 28%, 19% versus 11%, and 3% versus 1%, respectively. Adjusting for age, gender, histology, and stage of disease in the Cox regression model, the hazard ratio for survival in patients with lung cancer with diabetes mellitus was 0.55 (95% CI, 0.41–0.75) as compared with without.ConclusionPatients with lung cancer with diabetes mellitus have an increased survival compared with those without diabetes mellitus

Bronchoscopy using a head-mounted mixed reality device—a phantom study and a first in-patient user experience

Background: Bronchoscopy for peripheral lung lesions may involve image sources such as computed tomography (CT), fluoroscopy, radial endobronchial ultrasound (R-EBUS), and virtual/electromagnetic navigation bronchoscopy. Our objective was to evaluate the feasibility of replacing these multiple monitors with a head-mounted display (HMD), always providing relevant image data in the line of sight of the bronchoscopist.Methods: A total of 17 pulmonologists wearing a HMD (Microsoft® HoloLens 2) performed bronchoscopy with electromagnetic navigation in a lung phantom. The bronchoscopists first conducted an endobronchial inspection and navigation to the target, followed by an endobronchial ultrasound bronchoscopy. The HMD experience was evaluated using a questionnaire. Finally, the HMD was used in bronchoscopy inspection and electromagnetic navigation of two patients presenting with hemoptysis.Results: In the phantom study, the perceived quality of video and ultrasound images was assessed using a visual analog scale, with 100% representing optimal image quality. The score for video quality was 58% (95% confidence interval [CI] 48%–68%) and for ultrasound image quality, the score was 43% (95% CI 30%–56%). Contrast, color rendering, and resolution were all considered suboptimal. Despite adjusting the brightness settings, video image rendering was considered too dark. Navigation to the target for biopsy sampling was accomplished by all participants, with no significant difference in procedure time between experienced and less experienced bronchoscopists. The overall system latency for the image stream was 0.33–0.35 s. Fifteen of the pulmonologists would consider using HoloLens for navigation in the periphery, and two would not consider using HoloLens in bronchoscopy at all. In the human study, bronchoscopy inspection was feasible for both patients.Conclusion: Bronchoscopy using an HMD was feasible in a lung phantom and in two patients. Video and ultrasound image quality was considered inferior to that of video monitors. HoloLens 2 was suboptimal for airway and mucosa inspection but may be adequate for virtual bronchoscopy navigation

Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine?: A study of responding and non-responding cohort participants from a clinical spine surgery registry

Loss to follow-up may bias the outcome assessments of clinical registries. In this study, we wanted to determine whether outcomes were different in responding and non-responding patients who were included in a clinical spine surgery registry, at two years of follow-up. In addition, we wanted to identify risk factors for failure to respond. 633 patients who were operated for degenerative disorders of the lumbar spine were followed for 2 years using a local clinical spine registry. Those who did not attend the clinic and those who did not answer a postal questionnaire—for whom 2 years of outcome data were missing—and who would be lost to follow-up according to the standard procedures of the registry protocols, were defined as non-respondents. They were traced and interviewed by telephone. Outcome measures were: improvement in health-related quality of life (EQ-5D), leg pain, and back pain; and also general state of health, employment status, and perceived benefits of the operation. We found no statistically significant differences in outcome between respondents (78% of the patients) and nonrespondents (22%). Receipt of postal questionnaires (not being summoned for a follow-up visit) was the strongest risk factor for failure to respond. Forgetfulness appeared to be an important cause. Older patients and those who had complications were more likely to respond. Interpretation A loss to follow-up of 22% would not bias conclusions about overall treatment effects and, importantly, there were no indications of worse outcomes in non-respondents

Reasons for prolonged time for diagnostic workup for stage I-II lung cancer and estimated effect of applying an optimized pathway for diagnostic procedures

Background:Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time forlung cancer is 42 days. The aim of this study was to identify reasons for delays and estimate the effect on thetimelines when applying an optimal diagnostic pathway.Methods:Retrospective review of medical records of lung cancer patients, with stage I-II at baseline CT, receivingcurative treatment (n= 100) at a regional cancer center in Norway.Results:Only 40% started treatment within 42 days. The most important delays were late referral to PET CT (n= 27)and exercise test (n= 16); repeated diagnostic procedures because bronchoscopy failed (n= 15); and need for furtherinvestigations after PET CT (n= 11). The time from referral to PET CT until the final report was 20.5 days in median.Applying current waiting time for PET CT (≤7 days), 48% would have started treatment within 42 days (p=0.254).“Optimal pathway”was defined as 1) referral to PET CT and exercise test immediately after the CT scan and hospitalvisit, 2) tumor board discussion to decide diagnostic strategy and treatment, 3) referral to surgery or curativeradiotherapy, 4) tissue sampling while waiting to start treatment. Applying the optimal pathway, current waiting timefor PET CT and observed waiting times for the other procedures, 80% of patients could have started treatment within42 days (p< 0.001), and the number of tissue sampling procedures could have been reduced from 112 to 92 (−16%).Conclusion:Changing the sequence of investigations would significantly reduce the time until start of treatment incurative lung cancer patients at our hospital and reduce the resources needed

Medical complexity and time to lung cancer treatment - A three-year retrospective chart review

Background The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that ≥70% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35 days. However, delays can occur due to medical complexity. The aim of this study was to quantify the proportion of patients who started treatment within the recommended timeframes; and to assess the proportion of non-complex patients for which there were no good reasons for delays. Methods We performed a retrospective chart review of all patients diagnosed with lung cancer at a university hospital during 2011–2013. We defined “non-complex” patients as those who underwent ≤1 tissue diagnostic procedure and had no delays due to comorbidity, intercurrent disease or complications to diagnostic procedures (“Medical delays”) of more than three days. Results Four hundred forty-nine cases were analyzed; 142 (32%) had >1 tissue diagnostic procedures; 67 (15%) had medical delays >3 days; 262 (58%) were non-complex and 363 (81%) received treatment for lung cancer. Median number of days until surgery or radiotherapy was 48 (overall) and 41 (non-complex patients). The proportions who started surgery or radiotherapy within 42 days were 41% (overall) and 56% (non-complex). Corresponding numbers for systemic therapy were 29 days (overall) and 25 days (non-complex), and 64% (overall) and 80% (non-complex). Conclusion Fewer lung cancer patients than desired started treatment within the recommended timeframes. Even among the least complex patients, too few patients received timely treatment. The reasons need to be identified and understood, and changes in the organization appear to be necessary in order to offer timely treatment to more patients

Associations Between Time to Treatment Start and Survival in Patients With Lung Cancer

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