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A Look at Smoking Among Cancer Survivors

A Look at Smoking Among Cancer Survivors

The 2014 Surgeon General’s Report concluded that smoking by cancer patients and survivors increases overall mortality, cancer- specific mortality, and risk for second primary cancers. Studies have found that quit rates are initially quite high for patients with definitive smoking-related cancers. However, research has not dug deeper to assess smoking patterns many years after a cancer diagnosis among survivors of non-smoking-related cancers. Digging Deeper For a study published in Cancer Epidemiology, Biomarkers, & Prevention, Lee Westmaas, PhD, and colleagues analyzed data on nearly 3,000 patients 9 years after a diagnosis of one of 10 cancer types. “We wanted to know the overall prevalence of smoking, and especially how common non-daily smoking was,” says Dr. Westmaas. “We also wanted to see if prevalence differed by whether or not the cancer was smoking-related.” The researchers found that slightly more than 9% of all cancer survivors were current smokers. Among current smokers, 83% were deemed daily smokers, averaging nearly 15 cigarettes per day, and 40% smoked more than 15 cigarettes per day. The Figure depicts smoking prevalence by cancer type Dr. Westmaas speculates that bladder cancer survivors were most likely to continue smoking because their disease is relatively more survivable than other types of cancer. “It’s possible that those who still smoked felt they were at lower risk than smokers with some of the other cancers,” he says. The relatively high rate of continued smoking among lung cancer survivors could be the result of unique issues facing these patients. “Survivors of smoking- related cancer might have feelings of guilt or stigma from their diagnosis,” Dr. Westmaas says. “When those emotions are coupled...
Predicting COPD-Related Mortality in the Elderly

Predicting COPD-Related Mortality in the Elderly

About 10 years ago, researchers validated the BODE index—which stands for BMI, airflow obstruction, dyspnea, and exercise capacity—as a prognostic mortality risk tool for patients with COPD (Table 1). “The development and validation of the BODE index was an effort to more fully characterize disease severity in patients with COPD,” explains Melissa H. Roberts, MS, PhD. “It captures not only the clinical measurements of COPD through a lung function test, but also some of the systemic effects of the disease that can appear in patients with COPD.” Since 2004, many studies have demonstrated that the BODE index is a more accurate predictor of mortality among patients with COPD than lung function alone. Additional analyses have shown that the index can also serve as a good predictor of severe COPD exacerbations resulting in hospitalization. Over this same stretch of time, other studies have assessed modified versions of the BODE index to determine if other measurements may offer additional value, but these analyses have had mixed results. A Simpler Approach Although the BODE index has proven to be useful, research has suggested that implementing use of the tool can be challenging, oftentimes proving to be impractical if patients are debilitated. Recently, Dr. Roberts and colleagues examined a simplified, quasi-BODE index and published their results in the American Journal of Epidemiology. “The spirometry test for measuring FEV1 to determine airway obstruction and the 6-minute walk test for measuring exercise capacity are not always easy to obtain, especially in patients who are not ambulatory,” explains Dr. Roberts. “A substantial percentage of patients are unable to complete either or both of these tests. In...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
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