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1. Timeliness of surgery for early-stage lung cancer: Patient factors and predictorsCentral MessagePerspective

Author

Jeffrey Zhu, MSPH, Sydney Kantor, MBA, Jiafang Zhang, MS, Rowena Yip, PhD, MPH, Raja M. Flores, MD, Claudia I. Henschke, PhD, MD, and David F. Yankelevitz, MD

Subjects
delays, early-stage lung cancer, lung cancer, surgical delays, time to treatment, time to treatment initiation, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objectives: Time-to-treatment initiation is an important consideration for patients undergoing thoracic surgery for early-stage lung cancer because delays have the potential to adversely affect outcomes. This study seeks to quantify time-to-treatment initiation for patients with clinical stage I lung cancer, explore patient factors and predictors that lead to an increased time-to-treatment initiation, and compare surgeon perception of appropriate time-to-treatment initiation to the results. Methods: Time-to-treatment initiation was determined for patients enrolled in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment study who underwent surgical resection for clinical stage I lung cancer between March 2016 and December 2021. The following dates were determined: (1) date of first suspicious radiologic imaging, (2) date of first biopsy, and (3) date of surgery. A total of 15 thoracic surgeons who participated in the Mount Sinai Initiative for Early Lung Cancer Research on Treatment were assessed on their perception on time-to-treatment initiation. Results: For 638 patients, median time from first suspicious imaging findings to biopsy was 40 days, biopsy to surgery was 37 days, and suspicious imaging to surgery was 84 days. Significant factors that resulted in longer time-to-treatment initiation in the multivariate analysis were African American or Black race (P = .005), vascular disease (P = .01), and median household income less than $75,000 (P = .04). Although the surgeon's perception was that the average time from biopsy to surgery was 28 days, it was longer for 63.5% of participants; surgeon perception of maximum time between diagnosis and surgery was 84 days and longer for 28.7% of participants. Conclusions: Patient factors such as race, income, and comorbidities were found to have differences in time-to-treatment initiation. Delays to surgery exceeded the expectations of thoracic surgeons.

Published
2024
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2. New or enlarging hiatal hernias after thoracic surgery for early lung cancerCentral MessagePerspective

Author

Kimberly J. Song, MD, Rowena Yip, MPH, Michael Chung, MD, Qiang Cai, MD, PhD, Yeqing Zhu, MD, PhD, Ayushi Singh, MD, Erik E. Lewis, MD, David Yankelevitz, MD, Emanuela Taioli, MD, PhD, Claudia Henschke, MD, PhD, Raja Flores, MD, Andrew Kaufman, MD, Dong-Seok Lee, MD, Daniel Nicastri, MD, Andrea Wolf, MD, Kimberly Song, MD, Kenneth Rosenzweig, MD, Jorge Gomez, MD, Mary Beth Beasley, MD, Maureen Zakowski, MD, David F. Yankelevitz, MD, Claudia I. Henschke, PhD, MD, Rebecca Schwartz, MD, Huiwen Chan, Jeffrey Zhu, Sydney Kantor, Shana Adler, Wissam Raad, MD, Zrzu Buyuk, MD, Adie Friedman, MD, Ronald Dreifuss, MD, Stacey Verzosa, MD, Mariya Yakubox, NP, Karina Aloferdova, NP, Patricia Stacey, Simone De Nobrega, Ardeshir Hakami, MD, Harvey Pass, MD, Berne Crawford, MD, Jessica Donnington, MD, Benjamin Cooper, MD, Andre Moreirea, MD, Audrey Sorensen, RN, Leslie Kohman, MD, Robert Dunton, MD, Jason Wallen, MD, Christopher Curtiss, MD, Ernest Scalzetti, MD, Linda Ellinwood, RN, Clifford P. Connery, MD, Emilo Torres, MD, Dan Cruzer, MD, Bruce Gendron, MD, Sonya Alyea, NP, Daniel Lackaye, Lauren Studer, Claudia Henschke, PhD, MD, Rebecca Schwartz, PhD, Betsy Becker, PhD, Artit Jirapatnakul, PhD, Nan You, MS, Huiwen Chan, MPH, MBA, Claudia I. Henschke, David F. Yankelevitz, Rowena Yip, Artit Jirapatnakul, Raja Flores, Andrea Wolf, Daniel M. Libby, James P. Smith, Mark Pasmantier, A.P. Reeves, Steven Markowitz, Albert Miller, Jose Cervera Deval, Heidi Roberts, Demetris Patsios, Shusuke Sone, Takaomi Hanaoka, Javier Zulueta, Juan P. de-Torres, Maria D. Lozano, Ralph Aye, Kristin Manning, Christiana Care, Thomas Bauer, Stefano Canitano, Salvatore Giunta, Enser Cole, Karl Klingler, John H.M. Austin, Gregory D.N. Pearson, Dorith Shaham, Cheryl Aylesworth, Patrick Meyers, Shahriyour Andaz, Davood Vafai, David Naidich, Georgeann McGuinness, Barry Sheppard, Matthew Rifkin, M. Kristin Thorsen, Richard Hansen, Samuel Kopel, William Mayfield, Dan Luedke, Donald Klippenstein, Alan Litwin, Peter A. Loud, Leslie J. Kohman, Ernest M. Scalzetti, Richard Thurer, Nestor Villamizar, Arfa Khan, Rakesh Shah, Xueguo Liu, Gary Herzog, Diana Yeh, Ning Wu, Joseph Lowry, Mary Salvatore, Carmine Frumiento, David S. Mendelson, Michael V. Smith, Robert Korst, Jana Taylor, Michelle S. Ginsberg, Michaela Straznicka, Mark Widmann, Gary Cecchi, Terence A.S. Matalon, Paul Scheinberg, Shari-Lynn Odzer, David Olsen, Fred Grannis, Arnold Rotter, Daniel Ray, David Mullen, Peter H. Wiernik, Edson H. Cheung, Melissa Lim, Louis DeCunzo, Robert Glassberg, Harvey Pass, Carmen Endress, Mark Yoder, Palmi Shah, Laura Welch, Michael Kalafer, Jeremy Green, James Walsh, David Bertsch, Elmer Camacho, Cynthia Chin, James O'Brien, and James C. Willey

Subjects
hiatal hernia, lung cancer, paraesophageal hernia, postoperative complications, thoracic surgery morbidity, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia. Methods: Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non–small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site. Results: New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy; P = .047). The median size of new hernias was 21 mm, and the most commonly associated resection site was the left lower lobe (24.2%; P = .04). In patients with preexisting hernias, 53.5% demonstrated a small but significant increase in size from 21 to 22 mm (P

Published
2022
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3. Effects of Smoking, Obesity, and Pulmonary Function on Home Oxygen Use after Curative Lung Cancer Surgery

Author

Daniel G. Nicastri, Huiwen Chan, Nan You, Rowena Yip, Keval Ray, Emanuela Taioli, David F. Yankelevitz, Claudia I. Henschke, Raja M. Flores, Andrew Kaufman, Dong-Seok Lee, Andrea Wolf, Kenneth Rosenzweig, Jorge Gomez, Mary Beth Beasley, Maureen Zakowski, Michael Chung, Rebecca Schwartz, Jeffrey Zhu, Sydney Kantor, Shana Adler, Wissam Raad, Zrzu Buyuk, Adie Friedman, Ronald Dreifuss, Stacey Verzosa, Mariya Yakubox, Karina Aloferdova, Patricia Stacey, Simone De Nobrega, Ardeshir Hakami, Harvey Pass, Berne Crawford, Jessica Donnington, Benjamin Cooper, Andre Moreirea, Audrey Sorensen, Leslie Kohman, Robert Dunton, Jason Wallen, Christopher Curtiss, Ernest Scalzetti, Linda Ellinwood, Clifford P. Connery, Emilo Torres, Dan Cruzer, Bruce Gendron, Sonya Alyea, Daniel Lackaye, Lauren Studer, Betsy Becker, and Artit Jirapatnakul

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, Pulmonary function testing, Internal medicine, Carcinoma, Non-Small-Cell Lung, medicine, Humans, Obesity, Lung cancer, Pneumonectomy, Lung, Retrospective Studies, Lung cancer surgery, business.industry, Home oxygen, Smoking, Sequela, respiratory system, medicine.disease, respiratory tract diseases, Surgical morbidity, Oxygen, Pulmonary Diffusing Capacity, business
Abstract

Rationale: Lung cancer surgical morbidity has been decreasing, increasing attention to quality-of-life measures. A chronic sequela of lung cancer surgery is use of postoperative oxygen at home afte...

Published
2021

4. New or enlarging hiatal hernias after thoracic surgery for early lung cancer

Author

Kimberly J. Song, Rowena Yip, Michael Chung, Qiang Cai, Yeqing Zhu, Ayushi Singh, Erik E. Lewis, David Yankelevitz, Emanuela Taioli, Claudia Henschke, Raja Flores, Andrew Kaufman, Dong-Seok Lee, Daniel Nicastri, Andrea Wolf, Kimberly Song, Kenneth Rosenzweig, Jorge Gomez, Mary Beth Beasley, Maureen Zakowski, David F. Yankelevitz, Claudia I. Henschke, Rebecca Schwartz, Huiwen Chan, Jeffrey Zhu, Sydney Kantor, Shana Adler, Wissam Raad, Zrzu Buyuk, Adie Friedman, Ronald Dreifuss, Stacey Verzosa, Mariya Yakubox, Karina Aloferdova, Patricia Stacey, Simone De Nobrega, Ardeshir Hakami, Harvey Pass, Berne Crawford, Jessica Donnington, Benjamin Cooper, Andre Moreirea, Audrey Sorensen, Leslie Kohman, Robert Dunton, Jason Wallen, Christopher Curtiss, Ernest Scalzetti, Linda Ellinwood, Clifford P. Connery, Emilo Torres, Dan Cruzer, Bruce Gendron, Sonya Alyea, Daniel Lackaye, Lauren Studer, Betsy Becker, Artit Jirapatnakul, Nan You, Daniel M. Libby, James P. Smith, Mark Pasmantier, A.P. Reeves, Steven Markowitz, Albert Miller, Jose Cervera Deval, Heidi Roberts, Demetris Patsios, Shusuke Sone, Takaomi Hanaoka, Javier Zulueta, Juan P. de-Torres, Maria D. Lozano, Ralph Aye, Kristin Manning, Christiana Care, Thomas Bauer, Stefano Canitano, Salvatore Giunta, Enser Cole, Karl Klingler, John H.M. Austin, Gregory D.N. Pearson, Dorith Shaham, Cheryl Aylesworth, Patrick Meyers, Shahriyour Andaz, Davood Vafai, David Naidich, Georgeann McGuinness, Barry Sheppard, Matthew Rifkin, M. Kristin Thorsen, Richard Hansen, Samuel Kopel, William Mayfield, Dan Luedke, Donald Klippenstein, Alan Litwin, Peter A. Loud, Leslie J. Kohman, Ernest M. Scalzetti, Richard Thurer, Nestor Villamizar, Arfa Khan, Rakesh Shah, Xueguo Liu, Gary Herzog, Diana Yeh, Ning Wu, Joseph Lowry, Mary Salvatore, Carmine Frumiento, David S. Mendelson, Michael V. Smith, Robert Korst, Jana Taylor, Michelle S. Ginsberg, Michaela Straznicka, Mark Widmann, Gary Cecchi, Terence A.S. Matalon, Paul Scheinberg, Shari-Lynn Odzer, David Olsen, Fred Grannis, Arnold Rotter, Daniel Ray, David Mullen, Peter H. Wiernik, Edson H. Cheung, Melissa Lim, Louis DeCunzo, Robert Glassberg, Carmen Endress, Mark Yoder, Palmi Shah, Laura Welch, Michael Kalafer, Jeremy Green, James Walsh, David Bertsch, Elmer Camacho, Cynthia Chin, James O'Brien, and James C. Willey

Subjects
Pulmonary and Respiratory Medicine, Surgery, Cardiology and Cardiovascular Medicine
Abstract

The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia.Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non-small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site.New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy;Both open and minimally invasive lung resection for clinical early-stage lung cancer are associated with new or enlarging postoperative hiatal hernia, especially after resections involving the left lower lobe.

Published
2021

5. Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

Author

Raja Flores, Emanuela Taioli, David F. Yankelevitz, Betsy J. Becker, Artit Jirapatnakul, Anthony Reeves, Rebecca Schwartz, Rowena Yip, Esther Fevrier, Kathleen Tam, Benjamin Steiger, Claudia I. Henschke, Andrew Kaufman, Dong-Seok Lee, Daniel Nicastri, Andrea Wolf, Kenneth Rosenzweig, Jorge Gomez, Mary Beth Beasley, Maureen Zakowski, Michael Chung, David Yankelevitz, Claudia Henschke, Rita Futamura, Sydney Kantor, Carly Wallace, Faiz Bhora, Wissam Raad, Andrew Evans, Walter Choi, Zrzu Buyuk, Adie Friedman, Ronald Dreifuss, Stacey Verzosa, Mariya Yakubox, Karina Aloferdova, Patricia Stacey, Simone De Nobrega, Ardeshir Hakami, Harvey Pass, Berne Crawford, Jessica Donnington, Benjamin Cooper, Andre Moreirea, Audrey Sorensen, Leslie Kohman, Robert Dunton, Jason Wallen, Christopher Curtiss, Ernest Scalzetti, Linda Ellinwood, Ralph Aye, Eric Vallieres, Brian Louie, Alex Frivar, Vivek Mehta, Kristin Manning, Maria Chona, Andrew Smith, Clifford P. Connery, Emilo Torres, Dan Cruzer, Bruce Gendron, Sonya Alyea, Daniel Lackaye, Lauren Studer, and Betsy Becker

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, 030204 cardiovascular system & hematology, Radiosurgery, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Carcinoma, Non-Small-Cell Lung, medicine, Humans, Prospective Studies, Pneumonectomy, Lung cancer, Lymph node, Aged, Neoplasm Staging, business.industry, General surgery, Health Plan Implementation, medicine.disease, Institutional review board, Radiation therapy, Treatment Outcome, medicine.anatomical_structure, Oncology, Research Design, 030220 oncology & carcinogenesis, Mediastinal lymph node, Feasibility Studies, Lymph Node Excision, Female, business, Follow-Up Studies, Cohort study
Abstract

Introduction To maximize the benefits of computed tomographic screening for lung cancer, optimal treatment for small, early lung cancers is needed. Limiting the extent of surgery spares lung tissue, preserves pulmonary function, and decreases operative time, complications, and morbidities. It also increases the likelihood of resecting future new primary lung cancers. The goal is to assess alternative treatments in a timely manner. Methods The focus sessions with patients and physicians separately highlighted the need to consider their perceptions. Literature reviews and analyses of treatment results using large databases were performed to formulate critical questions about long-term treatment outcomes, recurrence, and quality of life of alternative treatments. Based on these analyses, the investigators developed a prospective multi-institutional cohort study, the Initiative for Early Lung Cancer Research for Treatment, to compare treatments for stage I NSCLC. HIPAA compliant institutional review board approval was obtained and we performed a feasibility study of the first 206 surgical patients. Results Lobectomy was performed in 89 (43.2%) patients, and sublobar resection was performed in 117 (56.7%) patients. Mediastinal lymph node resection was performed in 173 (84.0%) patients, 8 had N1 and 3 N2 lymph node metastases. Patients stated that both the surgeon's opinion (93%) and the patient's own opinion (93%) were extremely important, followed by the patients' view that the chosen procedure would provide the best quality of life (90%). Conclusions It was feasible to obtain pre- and postsurgical information from patients and surgeons. We anticipate statistically meaningful results about treatment alternatives in 3 to 5 years.

Published
2018
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