Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on selfreported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared selfreported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the ''gold standard,'' the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (k = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (k = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results. Validity of Self-reported Smoking Status among Participants in a Lung Cancer Screening TrialLung cancer is a devastating illness associated with substantial morbidity and mortality. In 2006, f174,470 Americans will be diagnosed with lung cancer, and another 162,460 will die from the disease (1). Improved survival with early diagnosis has prompted exploration of lung cancer screening technologies (2-5). In addition to the medical implications of early detection, participation in screening programs may be associated with decreased smoking rates (6-9), although some have suggested that negative screening results may actually lead to continuation of or return to smoking (6).Most studies exploring changes in smoking status associated with screening have relied solely on participant self-report of smoking status. The veracity of self-reports is often questionable in situations involving social pressure or medical disapproval (10-13). In these high-demand situations, studies have consistently suggested that smoking behavior is underreported (12-18). Although inaccurate self-reported smoking status in the general population occurs relatively infrequently (15,19), the lung cancer screening context may constitute a high-demand situation, a condition under which biochemical verification is recommended (1...

The results of these real-world analyses suggest progress in aRCC management and identified positive (nephrectomy, pazopanib vs. sunitinib or sorafenib) and negative (higher tumor grade and lung, bone, or liver metastasis) prognostic factors among patients receiving first-line targeted therapy.

• Warfarin is the primary oral anticoagulant currently recommended for the prevention of stroke for patients with atrial fibrillation (AF). Published evidence suggests that warfarin reduces the risk of stroke by approximately 64%.• The narrow therapeutic window of warfarin may result in insufficient anticoagulation, which may lead to stroke or over anticoagulation, which can increase the risk of bleeding. The incidence of major bleeding in AF patients receiving adjusted-dose warfarin has been reported as 1.1%.• Kim et al. (2010) Assessing the cost of warfarin-associated bleeding may more fully describe the costs associated with warfarin use.

BackgroundSkeletal muscle mass declines after the age of 50. Loss of skeletal muscle mass is associated with increased morbidity and mortality.ObjectiveThis study aims to identify predictors of low skeletal muscle mass in older adults toward development of a practical clinical assessment tool for use by clinicians to identify patients requiring dual-energy X-ray absorptiometry (DXA) screening for muscle mass.MethodsData were drawn from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2004. Appendicular skeletal mass (ASM) was calculated based on DXA scans. Skeletal muscle mass index (SMI) was defined as the ratio of ASM divided by height in square centimeters. Elderly participants were classified as having low muscle mass if the SMI was 1 standard deviation (SD) below the mean SMI of young adults (20–40 years old). Logistic regression was conducted separately in males and females age ≥65 years of age to examine the relationship between patients identified as having low muscle mass and health behavior characteristics, adjusting for comorbid conditions. The model was validated on a separate sample of 200 patients.ResultsAmong the NHANES study population, 551 (39.7 %) males and 374 (27.5 %) females had a SMI below the 1 SD cutoff point. NHANES study subjects with a low SMI were older (mean age, 76.2 vs. 72.7 for male; 76.0 vs. 73.7 for female; and both p < 0.0001) and had a lower body mass index (mean BMI, 24.1 vs. 29.4 for male; 22.9 vs. 29.7 for female; p < 0.0001). In adjusted logistic regression analyses, age (for males) and BMI (for both males and females) remained statistically significant. A parsimonious logistic regression model adjusting for age and BMI only had a C statistic of 0.89 for both males and females. The discriminatory power of the parsimonious model increased to 0.93 for males and 0.95 for females when the cutoff defining low SMI was set to 2 SD below the SMI of young adults. In the validation sample, the sensitivity was 81.6 % for males and 90.6 % for females. The specificity was 66.2 % for males and females.ConclusionsBMI was strongly associated with a low SMI and may be an informative predictor in the primary care setting. The predictive model worked well in a validation sample.

Aim: Targeted therapy (TT) and immuno-oncology (IO) drugs are approved for patients with BRAF mutant metastatic melanoma (MM). We compared real-world outcomes for first-line (1L) TT versus 1L IO to evaluate optimal sequencing. Materials & methods: Physicians-identified BRAF mutant MM patients initiating 1L TT or IO therapies and extracted treatment, disease and clinical outcomes including disease response which were compared between TT and IO and individual regimens. Results: 440 MM patients (TT = 283, IO = 157) were identified. A higher proportion of TT patients had liver metastases (46.3 vs 35.0%) and abnormal lactate dehydrogenase (61.1 vs 42.7%). IO-treated had a RECIST-determined response rate of 45.9 versus 60.1% for TT and time on treatment of 7.2 versus 11.4 months, respectively. There was no survival difference between cohorts. Conclusion: Despite higher risk patients, 1L TT resulted in higher response rate and longer treatment duration suggesting a preferred 1L sequence.