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Fernandez F.G.,Emory University | Furnary A.P.,Starr Wood Cardiac Group | Kosinski A.S.,Duke University | Onaitis M.W.,Duke University | And 6 more authors.
Annals of Thoracic Surgery | Year: 2016

Background The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) does not capture long-term survival after lung cancer surgery. Our objective was to provide longitudinal follow-up to the STS GTSD through linkage to Centers for Medicare and Medicaid Services (CMS) data for patients 65 years of age or older. Methods Lung cancer operations reported in the STS GTSD from 2002 through 2012 were linked to CMS data for patients 65 years of age or older using variables common to both databases with a deterministic matching algorithm. Mortality data were abstracted for each linked patient from the CMS data. The Kaplan-Meier method was used to estimate long-term survival for lung cancer surgery patients based on tumor stage. Results From 2002 through 2012, 60,089 lung cancer resections were identified in the GTSD, and 37,009 (61.7%) were in patients 65 years or older. Of these, 26,055 of 37,099 lung cancer resections (70%) in patients 65 years or older were successfully linked to CMS data. Failure to link was most commonly related to having a health maintenance organization or commercial insurance as the primary payer: 40.5% (5,290 of 13,065) of such patients were not linked from 2009 to 2012 (years payer data available). Median survival after lung cancer resection was 6.7 years for pathologic stage I, 3.5 years for stage II, 2.4 years for stage III, and 2.2 years for stage IV. Conclusions The CMS data complement the STS GTSD data by enabling examination of long-term survival and resource utilization in patients 65 years or older. Linked data from the STS GTSD and the CMS will allow for longitudinal analyses of comparative effectiveness among different surgical approaches for the treatment of lung cancer. © 2016 The Society of Thoracic Surgeons. Source

Juby A.G.,University of Alberta | Hanly M.G.,Baptist Anderson Cancer Center | Lukaczer D.,Direc Of Medical Education At The Institute For Functional Medicine
Maturitas | Year: 2016

Thyroid disease is common, and the prevalence is rising. Traditional diagnosis and monitoring relies on thyroid stimulating hormone (TSH) levels. This does not always result in symptomatic improvement in hypothyroid symptoms, to the disappointment of both patients and physicians. A non-traditional therapeutic approach would include evaluation of GI function as well as a dietary history and micronutrient evaluation. This approach also includes assessment of thyroid peroxidase (TPO) antibodies, T3, T4, and reverse T3 levels, and in some cases may require specific T3 supplementation in addition to standard T4 therapy. Both high and low TSH levels on treatment are associated with particular medical risks. In the case of high TSH this is primarily cardiac, whereas for low TSH it is predominantly bone health. This article discusses these important clinical issues in more detail, with some practical tips especially for an approach to the "non-responders" to the current traditional therapeutic approach. © 2016 Elsevier Ireland Ltd. All rights reserved. Source

Zaiden R.,Baptist Anderson Cancer Center | Zhou L.,Baptist Anderson Cancer Center | Kim G.P.,Baptist Anderson Cancer Center
Translational Cancer Research | Year: 2015

Pancreatic cancer (PC) is a complex and highly lethal malignancy. Surgery currently remains the only curative modality, although this cancer typically presents at advanced incurable stages. This obviates the use of definitive therapies and underscores the need for better systemic therapies. Unfortunately, limited progress has been made over the past decades with regard to effective treatment. Despite many clinical trials using combinations of various promising agents, there was no real improvement in outcomes until recently. Many of the molecular interactions involved were previously unrecognized and new approaches are now being investigated as a deeper understanding of the pathogenesis evolves. Newer therapies seeking to exploit known oncogenic pathways are being explored, along with alternate delivery mechanisms using conventional cytotoxic drugs. © 2011 - 2016 Translational Cancer Research. All rights reserved. Source

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