Tobacco.org

How Much Is Life Worth: Cetuximab, Non-Small Cell Lung Cancer, and the $440 Billion Question  

The spiraling cost of cancer care, in particular the cost of cancer therapeutics that achieve only marginal benefits, is under increasing scrutiny. Although health-care professionals avoid putting a value on a life, our limited resources require that society address what counts as a benefit, the extent to which cost should factor in deliberations, and who should be involved in these decisions. Professional societies, such as the American Society of Clinical Oncology, government agencies, including the Food and Drug Administration, and insurance companies should be involved. However, no segment of society is better qualified to address these issues than the oncology community. Oncologists must offer clear guidance for the conduct of research, interpretation of results, and prescription of chemotherapies. We review recent drug approvals and clinical trials and comment on their relevance to the issue of the spiraling cost of oncology therapeutics. We suggest some standards that would serve as a starting point for addressing these issues.

Jump to full article »

AUDIO: Non-Smokers Suffer Lung Cancer Stigma : NPR 

Morning Edition, June 29, 2009 · Smoking is such a well-known cause of lung cancer that many don't realize thousands who never smoked get the diagnosis. The great majority are women. Recent research shows it's really a different disease than smoking-related lung cancer. But those with the diagnosis say they suffer the same stigma.

Jump to full article »

Online Genetic Testing Appears to Have Benefits 

Online genetic testing for lung cancer appears to offer some benefits to patients, according to U.S. researchers who evaluated the use of an online test among 44 smokers.

"Up until now we have had a clear model for genetic testing. You see a professional genetics counselor, undergo a battery of tests and that professional helps you interpret your results," Saskia Sanderson, who conducted the study while at the social and behavioral research branch of the U.S. National Human Genome Research Institute, said in a news release from the American Association for Cancer Research.

"That model is coming under increasing pressure as more and more genetic information is generated, and as a greater number of genetic tests become available on the Internet," Sanderson added.

Jump to full article »

Secondhand Smoke in Pennsylvania Casinos: A Study of Nonsmokers’ Exposure, Dose, and Risk (PDF) 

Mining is described as the most dangerous industry.34 Sixteen Pennsylvania miners died in 15 disasters from 1995 to 2002, a rate of 1.2 deaths per10000 mine workers per year.34 The estimated rate of worker deaths per year from SHS is about 5 times the average annual death rate for Pennsylvania miners in coal mine disasters.

By the workplace standards of the US ½Q22 Occupational Safety and Health Administration ½Q20 (OSHA), which employs a 45-year average time period, casino workers’ risk from SHS-induced lung cancer and heart disease combined is 26 times the level indicating significant risk of material impairment.30

Pennsylvania’s new clean indoor air law permits smoking in 25% to 50% of casino floors. Confining smokers to a smaller area will increase the local smoker density in the smoking area and not protect nonsmoking areas from drifting or recirculated tobacco smoke. . . .

Conclusions

Despite ventilation rates per occupant 50% higher on average than those formerly recommended by ventilation engineers for smoking-permissible casinos, the average RSP concentration measured inside 3 Pennsylvania casinos in which smoking was permitted averaged 6 times that of outdoor levels; PPAH concentrations averaged 4 times outdoor levels, exposing both workers and patrons to harmful levels of air pollution. In the only casino with a separate nonsmoking floor, considerable amounts of RSPs and PPAHs infiltrated the nonsmoking salon. Based on measured RSP levels, SHS odor and irritation thresholds were massively exceeded in smoking areas and considerably exceeded in 1 nonsmoking salon. Using default values, the Active Smoker Model predicted combined RSP observations to within 14%.

Based on cotinine-derived RSP levels, SHS in Pennsylvania casinos produces an estimated excess mortality of approximately 6 deaths per year per 10000 workers at risk, 5 times the rate at which Pennsylvania coal miners have died in mining disasters and 26 times OSHA’s significant risk level. Nonsmoking workers or patrons exposed to casino SHS at the observed level of occupancy for 8 hours would experience ‘‘unhealthy air’’ according to the US Air Quality Index and, at maximum occupancy or exposure duration, ‘‘very unhealthy’’ air. Cotinine- derived PPAHs from SHS increases workers’ 24-hour exposure to PPAHs by an estimated 6-fold over measured outdoor background levels.

Further research is needed to generalize exposures observed in this study to the casino industry as a whole. It is clear, however, that Pennsylvania casino workers and patrons are put at significant excess risk of heart disease and lung cancer from SHS through a failure to include casinos in the state’s smoke-free-workplace law.

Jump to full article »

• Secondhand Smoke Threatens Casino Workers’ Health  

New research suggests that casino workers face a higher risk of heart disease and lung cancer because they work in buildings filled with tobacco smoke.

By one scientist’s calculation, six of every 10,000 nonsmoking casino employees in Pennsylvania will die each year because of exposure to secondhand smoke.

The estimate does not rely on the tracking of individual casino workers over time, nor does it compare them to workers who have not had smoke exposure. Still, the findings suggest a significant risk to the health of the workers, said study author James Repace, a Washington D.C.-area consultant who studies the effects of secondhand smoke.

Casino workers “are really the most exposed group in society now,” Repace said. “The only other group that’s exposed so much is bartenders,” but many states have banned smoking in bars and restaurants.

The Flight Attendant Medical Research Institute — which has studied the risk of secondhand smoke to flight attendants when airlines allowed smoking — funded the study. The casino findings appear online and in the August issue of the American Journal of Public Health.

Jump to full article »

Equality and better treatment sought for lung cancer patients  

But Weitz never smoked cigarettes - did nothing he knows of that would infect the delicate tissue of his lungs.

Yet even for those with lung cancer who have never smoked, the condition comes with a negative stereotype. They often are asked, "Did you smoke?"

It's a perception health advocates say needs to be shattered. Why, they ask, should state or federal funding toward the detection and treatment of lung cancer be any different than, say, for illnesses associated with obesity, alcoholism or other kinds of cancer?

"We have to get to the point of saying it doesn't matter," said Kim Norris, a Los Angeles resident who founded the Lung Cancer Foundation of America.

The foundation's goal is to raise enough funds to lead to lung cancer research and treatment. The five-year survival rates for all stages of lung cancer haven't changed in decades, a result of little progress toward finding better treatments, Norris said.

Norris and others note that research for lung cancer treatment remains "under-funded, under-researched and under-reported," because government funders view it as the "the black sheep" of cancers.

"Just because smoking is legal - and the Department of Defense once handed out cigarettes during wars - doesn't mean (those who smoked) deserve (lung cancer)."

Norris formed the foundation as a result of lessons learned when her husband, Roy, was diagnosed with lung cancer in 1997. She saw firsthand the lack in treatments and supported Roy as he tried five different lung cancer research clinical trials. . . .

Last month, the NIH launched research into early detection studies among those who have never smoked, which never existed for lung cancer.

Jump to full article »

British men 40% more likely to die from cancer than women  

British men are almost 40 per cent more likely than women to die from cancer-- and stereotypical behaviours like playing down early symptoms may be part of the reason, a new report suggests.

Researchers at the National Cancer Intelligence Network and Cancer Research U.K. released a report Monday that concludes British men are 16 per cent more likely than women to develop the disease in the first place.

The researchers looked at cancer as a whole, taking age into account while comparing men to women. When they excluded gender-specific malignancies like prostate and ovarian cancer and also lung cancer (since the disease and its main risk factor, smoking, are known to be more common in men), the gender gap became more much more pronounced.

Jump to full article »

• Nicotine Receptors Could Be Lung Cancer Treatment Target 

In a study of mice with lung cancer, a treatment that targeted nicotine receptors more than doubled the animals' survival time, Italian researchers say.

Nicotine plays a dual role in lung cancer. Changes in genes encoding nicotine receptors not only drive the urge the smoke, but also increase susceptibility to lung cancer. Exposure to nicotine boosts the expression of nicotine receptors, which leads to increased cell proliferation and inhibits the programmed cell death known as apoptosis.

In the new study, published in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine, the compound α-CbT dampened the expression of nicotine receptors and increased apoptosis, prolonging the lives of the mice.

"This research clearly has profound clinical implications regarding the role of nicotine in stimulating lung cancer and nicotine receptor antagonists in treating the disease," said Dr. John Heffner, past president of the American Thoracic Society, in a news release from the society. Heffner, who was not involved in the research, added, "The highly addictive nature of nicotine, however, complicates patients' ability to quit smoking and avoid ongoing nicotine exposure."

Previous research has shown that it's possible to dampen the response of nicotine acetylcholine receptors (nAChRs) using an antagonist called d-tubocurarine/α-Cobratoxin (α-CbT), which specifically targeted the area most linked to increased cell growth.

Jump to full article »

Lung Cancer Alliance Issues Statement on FDA Tobacco Regulation Bill 

Lung Cancer Alliance President Laurie Fenton Ambrose called its passage an historic moment in public history.

"This legislation recognizes that nicotine is a highly addictive drug that tobacco companies have deliberately used fraudulent and deceptive marketing to hook new smokers as young as possible, and must be regulated as the dangerous drug it is." she said.

"Hopefully this will help the millions of current smokers to finally quit once and for all," she said.

"And, hopefully too this will mark a new beginning for lung cancer research and early detection. Already over half of new cases are being diagnosed in former smokers and another 15% have never smoked at all," she pointed out.

"We have to stop blaming and start addressing the disease of lung cancer in its entirety. I believe that President Obama understands this and will start moving public health policy in this direction."

Jump to full article »

[H]opefully too this will mark a new beginning for lung cancer research and early detection. Already over half of new cases are being diagnosed in former smokers and another 15% have never smoked at all. We have to stop blaming and start addressing the disease of lung cancer in its entirety. I believe that President Obama understands this and will start moving public health policy in this direction.
Lung Cancer Alliance President Laurie Fenton Ambrose, on the FDA bill.

Does binge drinking increase the risk of lung cancer: results from the Findrink study  

Conclusion: Binge drinking is not associated with an increased risk of lung cancer among non-smokers but among smokers, it is associated with an increased risk irrespective of the number of cigarettes smoked daily. Even though the number of lung cancer cases among non-smokers was relatively small, the fact that the increased risk was limited to only smokers means that residual confounding by smoking may play a role. Larger studies are needed to clarify this association.

Jump to full article »

• Binge Drinking Increases Risk Of Lung Cancer In Smokers 

The risk of lung cancer increases for those smokers who have a tendency to binge drinking. This was found by the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), conducted at the University of Kuopio in Finland.

The KIHD study has followed up a cohort of men from eastern Finland for about 17 years. Binge drinking was found be associated with an increased risk of lung cancer among those who had smoked between 1 and 30 years regardless of how many cigarrettes a day they smoked. Meanwhile, binge drinking was not associated with any increased risk of lung cancer among non-smokers.

Jump to full article »

Cancer Diagnosis May Tax Physical, Mental Health  

A cancer diagnosis can take a physical and mental toll in the years after treatment, a new study says.

Bryce B. Reeve of the U.S. National Cancer Institute and a team of researchers looked at the health-related quality of life of 1,432 people 65 years of age or older who were diagnosed with cancer of the prostate, breast, bladder or kidney, non-small cell lung cancer, colorectal cancer or non-Hodgkin lymphoma between 1998 and 2003. Similar data was examined for 7,160 similar people without cancer.

Up to two years after diagnosis, those with cancer reported decreased physical health compared with those of the same age who did not have cancer, the researchers found. People with prostate, colorectal and non-small cell lung cancer reported decreased mental health compared with people without cancer, they noted.

"We expect this study to provide a benchmark for capturing the burden of cancer on health-related quality of life and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects," Reeve's team wrote.

The study appears in the June 9 online edition of the Journal of the National Cancer Institute.

Jump to full article »

Impact of Cancer on Health-Related Quality of Life of Older Americans 

Background: The impact of cancer on health-related quality of life (HRQOL) is poorly understood because of the lack of baseline HRQOL status before cancer diagnosis. To our knowledge, this is the first population-based study to quantify the nature and extent of HRQOL changes from before to after cancer diagnosis for nine types of cancer patients and to compare their health with individuals without cancer.

Methods: The Surveillance, Epidemiology, and End Results cancer registry data were linked with the Medicare Health Outcomes Survey (MHOS) data . . .

Conclusion: These findings provide validation of the specific deleterious effects of cancer on HRQOL and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects. . . .

Contribution

All cancer patients, except melanoma and endometrial cancer, had lower mean physical health scores than control subjects, but only patients with colorectal, prostate, and lung cancers had lower mean mental health scores than control subjects. Patients with prostate, bladder, colorectal, kidney, or lung cancer or NHL reported greater declines in their social roles and well-being than controls.

Jump to full article »

Smokers can take cancer risk test 

New Zealand researchers said yesterday they have developed the world's first test to measure the risk for individual smokers and ex-smokers of developing lung cancer.

The test combines results of DNA analysis with other risk factors such as age, diseases such as bronchitis and emphysema and family lung cancer history, said University of Auckland associate professor Robert Young.

"All smokers face an increased risk of developing lung cancer, among a host of other serious health problems, but for some individuals the risk is much greater than for others," Young said.

"With this test, doctors will be able to identify those at greatest risk while there is still time to help."

The test obtains a patient's DNA from a simple mouth swab.

Jump to full article »

Sleuths follow lung stem cells for generations to shed light on healing 

than one kind of stem cell is required to support the upkeep and repair of the lungs, according to a new study published in the journal Cell Stem Cell.

Scientists at Duke University Medical Center painstakingly followed and counted genetically labeled cells in the mouse lung for over a year, under differing conditions, to learn more about natural renewal and healing processes. This information may shed light on what goes wrong in conditions like lung cancer, chronic bronchitis and asthma.

"We are learning the exact processes that maintain the various regions of the lung in tip-top condition and what happens when things go wrong," said Brigid Hogan, Ph.D., chair of the Duke Department of Cell Biology and senior author of the study. "Normally, the lung is beautifully organized, with the exact proportion of secretory and ciliated cells lined up next to each other to get their jobs done." The secretory cells lubricate and protect, while the hair-like projections of the ciliated cells waft the secretions up and out of the lungs.

In humans, under conditions of heavy smoking, or infection or inflammation due to asthma or cystic fibrosis, repeated cycles of damage and repair lead to a messy arrangement, she said. "You can get patches of cells building up in a stacked, flattened formation like skin cells. Some cells multiply too fast; others may make too much mucus."

Jump to full article »