What are the clinical symptoms and physical signs for non ‐small cell lung cancer before diagnosis is made? A nation‐wide multicenter 10‐year retrospective study in China
This is a nation ‐wide multicenter 10‐year cross‐sectional study in China. This paper tried to objectively examine the symptoms and physical signs in lung cancer patients, and determine whether lung cancer symptoms were independently associated with diagnosis. We found that the symptoms and physical signs were associated with stage and pathologic diagnosis of NSCLC. AbstractBackgroundMost lung cancer patients are diagnosed after the onset of symptoms. However, whether the symptoms of lung cancer were independently associated with the diagnosis of lung cancer is unknown, especially in the Chinese population.MethodsWe conducted a 10 years (2005 ‐2014) nationwide multicenter retrospective clinical epidemiology study of lung cancer patients diagnosed in China. As such, this study focused on nonsmall cell lung cancer (NSCLC). We calculated the odds ratios (ORs) for variables associated with the symptoms and physical signs using multivariate unconditional logistic regressions.ResultsA total of 7184 lung cancer patients were surveyed; finally, 6398 NSCLC patients with available information about their symptoms and physical signs were included in this analysis. The most common initial symptom and physical sign was chronic cough (4156, 65.0%), followed by sputum with blood (2110, 33.0%), chest pain (1146, 17.9%), shortness of breath (1090, 17.0%), neck and supraclavicular lymphadenectasis (629, 9.8%), weight loss (529, 8.3%), metastases pain (378, 5.9%), fatigue (30...
Curious what each providers breakdown is approx percentage wise new Level 2: 0 Level 3: 40 Level 4: 60 return Level 2: 5 Level 3: 65 Level 4: 30 never bill 1 or 5
“The tide of time flow’d back with me,The forward-flowing tide of time;And many a sheeny summer-morn,A down the Tigris I was borne,By Baghdad’s shrines of fretted gold,High-walled gardens green and old;”From “Recollections of the Arabian Nights”Alfred Lord Tennyson
Every few years, a new staging system is published, and we have survived many in the past 30 years. Each succeeding one is more complex and difficult to memorize. At the end of our careers, we have to admit giving up to some extent on learning the nuances of our most recent version. Additionally, we have witnessed our residents wasting countless hours trying to memorize this cobweb of minutia. Would their time not be more productively spent learning about patient care and outcomes?
First, and perhaps most importantly, Dinh et al are to be applauded for presenting their prospective series of men treated with proton therapy at the University of Washington and their carefully reported rectal toxicity outcomes in the context of dose-volume histogram analysis as well as differing rectal immobilization devices.1 These result s provide strong evidence suggesting that without the use of a rectal spacer, there is increased rectal toxicity with proton therapy compared with intensity modulated radiation therapy (IMRT).
Concurrent chemoradiation, the mainstay of treatment in locally advanced head and neck cancer, is a challenging endeavor even for the fittest of individuals. On one hand, it confers superior therapeutic outcomes compared with either chemotherapy or radiation alone; on the other hand, the high-intensity treatment is associated with substantial treatment toxicity that in turn leads to treatment schedule interruption or incompletion, hospitalization, or even death.1-4
The recent meta-analysis of the dose-response rate of prostate cancer biochemical control during hypofractionated radiation therapy by Vogelius and Bentzen1 showed that the standard linear-quadratic model was insufficient to model the observed clinical response. They proposed 2 possible corrections: either (1) the slope of the α/β ratio increases by 0.6 for every Gray of increase in the dose per fraction or (2) there is an arbitrary limit to the dose-response curve at 80 Gy.
We thank Drs. Alfonso and Berk for their interest1 in our meta-analysis of outcome data from randomized controlled trials of hypofractionated radiation therapy for low-risk prostate cancer.2 Specifically, we showed how the recently published study of ultrahypofractionated radiation therapy by Widmark et al3 provides further evidence for a diminishing benefit from radiation therapy intensified by increasing the dose per fraction.2 This is a purely empirical observation and does not rely on any mechanistic assumptions.
No single question in radiation oncology has been investigated as exhaustively as the appropriate fractionation for treating patients with uncomplicated bone metastases. A single fraction of 8 Gy was equivalent to multiple prolonged fractionation schemes in 29 randomized trials and 3 meta-analyses, whether measured by overall response rate, complete response rate, partial response rate, time to pain relief, time to progression of disease, durability of response, development of spinal cord compression, or development of pathologic fracture.
We appreciate the authors for their letter1 highlighting the complex issues of predicting survival and treatment toxicity in patients with head and neck cancer (HNC) before definitive chemoradiation therapy.
This study concluded that vulnerability, as measured by comprehensive geriatric assessment (CGA), was independently associated with poorer survival and hig her treatment-related toxicities.1