Purpose: To collect data from the initial evaluation of patients referred for a second opinion to a specialist pulmonary oncology clinic and compare these with the data of the re-evaluation (second opinion) conducted there to identify discrepancies in diagnosis, stage and therapeutic advice. Methods:Demographics and disease characteristics of 188 patients referred between January 2005 to December 2009 were collected from medical records, next to therapeutic advice. The data of both initial and second evaluations were compared with each other.Results: At time of referral, the (clinical/histopathological) diagnosis was known in 174 patients (92.6%) and the stage in 162 patients (86.2%). Forty-eight percent of the patients had received prior therapy and 73% a therapeutic advice. Next to data review, additional diagnostic procedures were performed in 68% of the patients. There were discrepancies between the initial and second opinion in diagnosis (17 patients, 9%), stage (24 patients, 13%) and therapeutic advice (70 patients, 37%). The second opinions led to a total of 91 discrepancies, 53 of these had a potential major impact on patient outcomes in terms of survival, morbidity and quality of life. For patients with advanced lung cancer, the results were similar but the number of changed stages, therapeutic advices and discrepancies with a potential impact on patient outcomes were slightly higher (15%, 40% and 51% respectively). Conclusions:Lung cancer second opinions referrals led to significant discrepancies in diagnosis and therapeutic advice in a substantial number of patients. This might be translated in better (palliative) care.

Objectives Gaining knowledge of dynamic processes of mechanisms underlying mindfulness-based cognitive therapy (MBCT) for recurrent depression could help to improve treatment efficacy. The current study examined the overall course and week-toweek associations of mindfulness and positive/negative affect during MBCT for recurrent depression. Methods Using data from the MOMENT study, 235 patients with recurrent depression in (partial) remission allocated to MBCT were included. Prior to each MBCT session, self-reports were obtained on mindfulness, positive affect, and negative affect. Results Autoregressive latent trajectory (ALT) modeling revealed that, across the MBCT course, larger increases in mindfulness were associated with larger increases in positive affect (r = .80, p < .050). Higher general levels of negative affect were associated with smaller increases in mindfulness over time (r = −.26, p < .001). Week-to-week effects showed no reciprocal cross-lagged effects between mindfulness and positive affect or negative affect, except for positive affect at session 2 which was positively associated with mindfulness at session 3 (r = .11, p < .050). Conclusions The current study supports a positive association in strength of increase between mindfulness and positive affect, while higher general levels of negative affect might be associated with smaller increases of mindfulness during MBCT for recurrent depression. For future research, experience sampling methods (ESMs) are recommended to capture dynamics on a smaller time scale. ALT modeling techniques are advised to be better able to interpret the processes of stability and change during MBCT for recurrent depression.

Environmental factors may play a role in how the personality trait sensory processing sensitivity (SPS) relates to different health-related outcomes. To better understand vulnerability and resilience in different environments, we investigated associations of SPS with stress-related and neurodevelopmental disorder traits, well-being, and somatic health in a population-based sample of 252 adults. We then tested SPS interactions with lifetime or current measures of positive or negative environments. Overall, higher SPS related to more burnout, anxiety, depression, stress, health complaints and nonprescription medication use, but not to neurodevelopmental disorder traits. Associations with burnout, anxiety, and health complaints remained after controlling for neuroticism. In unfavorable environments, higher SPS related to worse health while, in favorable environments, it related to better health, supporting the theory of SPS as a factor for differential susceptibility to environments. Our work demonstrates that SPS may be a risk factor for stress-related and somatic symptoms, independent of neuroticism.

Background: The finding of a renal mass on imaging is suggestive of metastatic non-small cell lung cancer in the presence of a lung tumor but can also have another origin. Case Report: We describe the case of a patient diagnosed with stage IV lung cancer based on a renal metastasis. A second opinion including review of histopathological data and additional imaging followed by lung surgery and cryoablation of the kidney lesion revealed two tumors of different origins, non-small cell lung cancer and a renal cell carcinoma. Discussion: The presence of a renal mass diagnosed on a CT scan in a patient with lung cancer is not always synonymous with metastatic disease. Confirmation of diagnosis by tissue sampling is mandatory, especially if a synchronous primary tumor is possible.

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Ziel: Cisplatin/5-Fluorouracil (5-FU) ist ein anerkanntes palliatives Chemotherapie-Schema bei Plattenepithelkarzinomen der Kopf-Hals-Region, das die Lebensqualität erhöht, jedoch nicht das Gesamtüberleben verlängert. Durch Verwendung von Capecitabin anstelle von 5-FU entfällt die Morbidität einer Infusionsbehandlung, was von potenziellem Nutzen für das Wohlbefinden des Patienten ist. In dieser Studie werden die Behandlungsergebnisse unter Cisplatin plus Capecitabin (PX) außerhalb eines Studien-Settings betrachtet.Methoden: Die Daten konsekutiver Patienten, die eine solche Behandlung in einem Zentrum erhalten hatten, wurden retrospektiv analysiert. Cisplatin (mittlere Dosis: 75 mg/m²) wurde an Tag 1 und Capecitabin (mittlere Dosis: 808 mg/m² zweimal täglich) an den Tagen 1-14 eines 3-wöchigen Zyklus verabreicht; insgesamt wurden bis zu 6 Zyklen durchgeführt.Ergebnisse: 65 Patienten (Altersmedian: 58,6 Jahre) erhielten im Median 4 Zyklen Chemotherapie. Die Gesamtansprechrate betrug 30,7% bei einem medianen Gesamtüberleben von 7,3 Monaten. Die Behandlung wurde gut vertragen; bei 10,7% traten Neutropenien 3. Grades, bei 1,5% solche 4. Grades auf; weitere Toxizitäten vom Schweregrad 4 kamen nicht vor. Ein Patient verstarb unter der Therapie an neutropenischer Sepsis. Wegen Nebenwirkungen brachen 27% der Patienten die Chemotherapie vorzeitig ab.Schlussfolgerung: Die außerhalb klinischer Studien durchgeführte PX-Behandlung wurde gut vertragen. Die Ergebnisse sind vergleichbar mit denen früherer Publikationen. Durch die einfache Verabreichung und den Nutzen im Hinblick auf den Patientenkomfort stellt sie eine attraktive Alternative zur Standard-Palliativtherapie dar.Übersetzung aus Chemotherapy 2013;59:1-7 (DOI: 10.1159/000348816)

Background Home practice is considered a key element in increasing treatment effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression. However, long-term longitudinal research into the associations between home practice and depression outcomes is scarce. The current study examined the prospective associations between the extent of formal home practice and subsequent depression severity during 15 months of follow-up. Methods Data from two randomized-controlled trials on MBCT for recurrent depression were used (n = 200). Depressive symptoms were assessed at 3-month intervals: 0 (baseline), 3 (posttreatment), 6, 9, 12, and 15 months. Formal home practice frequency was calculated for each 3-month period. Autoregressive latent trajectory (ALT) modelling was applied. Results Participants practiced formal exercises on 57% (SD = 0.22, range 0-1) of the days during MBCT, equivalent to an average of 4 days per week, which showed a rapid decline after MBCT. The level of depressive symptoms did not change over the full study period. A small positive association was found between formal home practice frequency during each three-month period on subsequent depressive symptoms, but sensitivity analyses did not confirm this. More robust, a small negative association was found between levels of depressive symptoms at each measurement point and formal home practice frequency during the subsequent three-month periods. Conclusions The hypothesis that more frequent home practice would lead to reductions in depressive symptoms was not confirmed in the current study. Rather, it seems that patients with higher levels of depression may subsequently practice less frequently at home. The interplay between home practice and outcome might not be as straightforward as expected. However, these results are preliminary and should be replicated first before recommendations for clinical practice can be formulated.