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Biomedical subjects

Michael Simoff

Publications and source records attributed to Michael Simoff.

6 recordsLinked to original sources
PubMed2004

Lung carcinoma symptoms--an independent predictor of survival and an important mediator of African-American disparity in survival.

BACKGROUND: The extent of disease in patients with lung carcinoma is reflected morphologically by stage and pathophysiologically by sign/symptoms. This study evaluates the associations between symptoms and stage, the independent impact of symptoms on survival, predictors of symptoms, and the extent to which symptoms mediate survival disparities. METHODS: Data from 1154 patients with lung carcinoma were collected from the authors' tumor registry and by abstraction of medical records. Associations were evaluated by logistic and Cox regression analyses. RESULTS: Symptomatic diagnoses were associated with advanced disease stage (odds ratio [OR], 4.53; 95% confidence interval [95%CI], 3.17-6.48). Hoarseness, hemoptysis, dyspnea, noncardiac chest pain, extrathoracic pain, neurologic symptoms, weight loss, and weakness/fatigue (adverse symptoms) were associated independently with relatively higher/advanced stage and/or reduced survival. Adverse symptoms (> or = 1 vs. 0) predicted reduced survival independently of stage and other prognosticators (hazard ratio [HR], 1.84; 95%CI, 1.52-2.21). Independent predictors of adverse symptoms included gender (OR(male vs. female), 1.50; 95%CI, 1.11-2.01), race/ethnicity (OR(black vs. white), 1.62; 95%CI, 1.18-2.21), and marital status (OR(spouseless vs. not), 1.79; 95%CI 1.31-2.45). The hazard ratios (HR; black vs white), univariate, adjusted for stage, and adjusted for stage and adverse symptoms, was 1.206 (95%CI, 1.05-1.38), 1.165 (95%CI, 1.01-1.34), and 1.075 (95%CI, 0.94-1.26), respectively. Adverse symptoms explained 43% of race/ethnic survival disparity beyond stage. CONCLUSIONS: Symptoms were associated with disease stage, yet both were important, independent predictors of survival; and symptoms explained an important amount of race/ethnic disparity in the survival of patients with lung carcinoma. Symptomatology needs to be incorporated into cancer clinical trials and into outcomes and disparities research.

Black or African American↗
PubMed2004

In lung cancer patients, age, race-ethnicity, gender and smoking predict adverse comorbidity, which in turn predicts treatment and survival.

OBJECTIVE: This study evaluates the relationship between sociodemographic/exposure factors and comorbidity, and their impact on lung cancer treatment and survival. STUDY AND DESIGN SETTING: Data for 1,155 patients were abstracted from the Josephine Ford Cancer Center Tumor Registry and medical records. Associations were analyzed by linear, logistic, and Cox regression. RESULTS: Approximately 88% of patients had > or = 1 of 56 comorbidities assessed. In multivariate analysis, comorbidity count was associated with older age, pack-years smoked, heavy alcohol use, lower socioeconomic status (SES), and female gender. Approximately 63% of patients had > or = 1 of 18 adverse prognostic comorbidities (AC), and significant independent predictors of AC were age, pack-years, African-American race/ethnicity, and gender. In multivariate analysis, comorbidity count and AC predicted nonreceipt of surgery in localized disease (OR(> or = 1 vs. 0 AC)=0.38, 95% 0.18, 0.81) and chemotherapy in advanced disease (OR > or = 1 vs. 0 AC)=0.72, 95% 0.51, 1.00). In adjusted analysis, comorbidity predicted survival in localized (hazard ratio (HR)(> or = 2 vs. 0 AC)=2.99, 95% CI 1.75, 5.10) and advanced lung cancer (HR(> or = 2 vs. 0 AC)=1.56, 95% CI 1.25, 1.94). CONCLUSION: Comorbidity has important deleterious effects on lung cancer outcomes and significant predictors of comorbidity included age, smoking, race/ethnicity, SES, alcohol, and gender.

Age Factors↗
PubMed2004

Smoking and lung cancer survival: the role of comorbidity and treatment.

STUDY OBJECTIVE: Numerous studies indicate that smoking is associated with poorer outcomes in patients with cancer. The aim of this study was to determine whether smoking independently predicts survival in patients with lung cancer or whether an existent effect is mediated through comorbidity and/or treatment. DESIGN AND SETTING: Cox proportional hazards analysis was used to study a cohort of 1,155 patients with lung cancer diagnosed at the Henry Ford Health System between 1995 and 1998, inclusive. RESULTS: Adjusted for the baseline covariates, age, gender, illicit drug use, adverse symptoms, histology, and stage, the hazard ratio (HR) for smoking (current vs former/never) was 1.37 (95% confidence interval [CI], 1.18 to 1.59; p < 0.001). Adjusted for the baseline covariates and for 18 deleterious comorbidities, the HR for smoking was 1.38 (95% CI, 1.18 to 1.60; p < 0.001), indicating that the hazardous effect of smoking was not mediated through comorbidity. Current smoking was inversely associated with treatment (any surgery and/or chemotherapy and/or radiation therapy vs none) [odds ratio, 0.73; 95% CI, 0.55 to 0.98 (p = 0.03)]. Adjusted for baseline covariates, comorbidities and treatment, the HR for current smoker vs former/never was 1.26 (95% CI, 1.08 to 1.47; p = 0.003), a decline of 30.7% explained by treatment (HR for any treatment vs none, 0.40; 95% CI, 0.33 to 0.48; p < 0.001). CONCLUSIONS: Current smoking at diagnosis is an important independent predictor of shortened lung cancer survival. That this effect was not explained by sociodemographic/exposure factors, adverse symptoms, histology, stage, comorbidity, and treatment suggests that it may be mediated through direct biological effects.

Aged↗
PubMed2003

Impact of comorbidity on lung cancer survival.

Lung cancer is associated with smoking and age, both of which are associated with comorbidity. We evaluated the impact of comorbidity on lung cancer survival. Data on 56 comorbidities were abstracted from the records of a cohort of 1,155 patients. Survival effects were evaluated with Cox regression (outcome crude death). The adjusted R(2) statistic was used to compare the survival variation explained by predictive variables. No comorbidity was observed in 11.7% of patients, while 54.3% had 3 or more (mean 2.97) comorbidities. In multivariate analysis, 19 comorbidities were associated with survival: HIV/AIDS, tuberculosis, previous metastatic cancer, thyroid/glandular diseases, electrolyte imbalance, anemia, other blood diseases, dementia, neurologic disease, congestive heart failure, COPD, asthma, pulmonary fibrosis, liver disease, gastrointestinal bleeding, renal disease, connective tissue disease, osteoporosis and peripheral vascular disease. Only the latter was protective. Some of the hazards of comorbidities were explained by more directly acting comorbidities and/or receipt of treatment. Stage explained 25.4% of the survival variation. In addition to stage, the 19 comorbidities explained 6.1%, treatments 9.2%, age 3.7% and histology 1.3%. Thirteen uncommon comorbidities (prevalence <6%) affected 21.2% of patients and explained 3.5% of the survival variation. Comorbidity count and the Charlson index were significant predictors but explained only 2.5% and 2.0% of the survival variation, respectively. Comorbidity has a major impact on survival in early- and late-stage disease, and even infrequent deleterious comorbidities are important collectively. Comorbidity count and the Charlson index failed to capture much information. Clinical practice and trials need to consider the effect of comorbidity in lung cancer patients.

Age Distribution↗
PubMed2003

Lung cancer. Palliative care.

The majority of patients who acquire lung cancer will have troublesome symptoms at some time during the course of their disease. Some of the symptoms are common to many types of cancers, while others are more often encountered with lung cancer than other primary sites. The most common symptoms are pain, dyspnea, and cough. This document will address the management of these symptoms, and it will also address the palliation of specific problems that are commonly seen in lung cancer: metastases to the brain, spinal cord, and bones; hemoptysis; tracheoesophageal fistula; and obstruction of the superior vena cava.

Analgesics↗