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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