Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.

Seniors dying with poor-prognosis cancer experience high-intensity care with rates varying by age, gender, and race.

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Abstract Background We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality. Methods We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System. Results Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79). Conclusion Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.

There is considerable room for improvement in helping older patients with ovarian cancer initiate and complete chemotherapy. The oldest women who completed chemotherapy in this study did not use health services more than younger women did. Treatment teams for older patients with ovarian cancer should include expertise in geriatric assessment, should carefully identify medical and psychosocial barriers to completing treatment, and should support patients throughout treatment.

Background Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by deficiency in endoglin, an angiogenic protein. The net effect of endoglin expression on cancer outcomes from animal studies has proven controversial. We evaluated whether reduced systemic endoglin levels, expected in patients diagnosed with HHT, impacted clinical outcomes for cancer. Methods A retrospective cohort analysis using SEER-Medicare was conducted to evaluate the effect of HHT on survival among patients diagnosed with breast, colorectal, lung, or prostate cancer between 2000 and 2007 (n=540,520). We generated Kaplan-Meir survival curves and Cox models to compare the effect of HHT on all cause survival for a composite of the four cancers, and separate models by cancer, adjusting for demographic variables, cancer type, cancer stage, and comorbidities. Results All cause survival analysis for a composite of the four cancers showed an adjusted hazard ratio of 0.69 (95% confidence interval (CI) of 0.51-0.91, p=0.009) for HHT, indicating significantly improved survival outcome. When stratified by cancer type, HHT diagnosis showed a significant protective effect among breast cancer patients with an adjusted hazard ratio of 0.31 (CI: 0.13-0.75, p=0.009). Conclusions There was a significant association between HHT and improved survival outcome for a composite of patients with breast, prostate, colorectal, and lung cancer, and in analysis stratified by cancer, the association was significant for HHT patients with breast cancer.

Affective heritage embracement, a collective narrative of nostalgia, is identified at two popular music festivals. “MusicFest” embraces a tradition of “Red Dirt” country music through performance (music festival), whereas the “Walnut Valley Festival” embraces a bluegrass/folk musical heritage through performance and participation (musicians' festival). The symbolic importance of musical interaction is explored to highlight the experienced emotionality that leads to the affective ties that bind these otherwise temporary communities. This collective narrative reveals the various functions of nostalgia wherein collective sentiment both reflects and creates the perceived authentic experiences of festival attendees.

Gradual expansion of a lung bulla is common and may be associated with debilitating pulmonary symptoms. The aetiology of bulla expansion is unclear. Spontaneous regression, on the other hand, is rarely observed. The case is presented of a man in whom near complete spontaneous resolution of a giant pulmonary bulla occurred. This event was associated with dramatic improvement in the radiographic picture and pulmonary function. (Thorax 1996;51:549-550) Keywords: emphysema, giant bulla, spontaneous regression, pulmonary function.Progressive deterioration in his pulmonary function coincided with the gradual enlargement of a large right lung bulla. Diffuse emphysematous changes on computed tomographic (CT) scanning and a low diffusing capacity precluded consideration of bullectomy.On routine follow up spirometric testing in October 1993 the patient's lung function was noted to be markedly improved (table). Repeat spirometric testing verified a 1-54 1 increase in forced expiratory volume in one second (FEV,).The chest radiograph showed a significant reduction in the size of the right lung bulla as well as a new 2 cm right lower lung nodule. Further evaluation included repeat CT scanning, bronchoscopic examination, and a lung perfusion scan. The CT scan confirmed a remarkable reduction in the size of the bulla compared with previous studies (figure). The 2 cm right lower lobe solitary nodule was not associated with mediastinal adenopathy. No endobronchial lesions were identified at bronchoscopy. The lung perfusion scan showed 52% of total flow to the right lung, significantly greater than the 20% observed in 1989. The patient subsequently underwent resection of a benign lung nodule.