Longitudinal study to assess impact of smoking at diagnosis and quitting on 1-year survival for people with non-small cell lung cancer.

OBJECTIVES: To update the prevalence of smoking in people as they were diagnosed with non-small cell lung cancer (NSCLC) and to see whether smoking status at baseline and quitting are independently associated with 1-year survival. DESIGN: A real-world cohort study following patients from diagnosis for up to 1 year or until death. SETTING: UK multi-centre study (28 sites) based in secondary and primary care. PARTICIPANTS: 1124 patients with newly diagnosed NSCLC between 2010-2016. MAIN OUTCOME MEASURES: Smoking status was validated at diagnosis and at every routine and emergency hospital visit. Cancer treatments were offered according to local multi-disciplinary team decisions following UK guidelines and smoking cessation treatments offered according to local practice /availability. Survival analysis and Cox Proportional Hazards Modelling examined the associations of a) smoking at baseline and b) quitting smoking, on survival at 1 year. RESULTS: 77% of never smokers, 60% of ex-smokers and 57% of current smokers, were alive at 1 year (p = 0.01). After adjusting for age, stage, EGOG, surgery and gender, ex smokers (adjusted HR 1.96, 95% CI 1.16-2.31) and current smokers (aHR 2.04, 1.19-3.48) were both more likely to die within one year. 23% of smokers with NSCLC quit within 3 months of diagnosis. At 1 year, 69% of those who quit were alive versus 53% of those who continued to smoke (p < 0.01). After adjusting the risk of dying was lower (aHR 0.75), in those who quit smoking, although this was not statistically significant (p = 0.23). CONCLUSIONS: This is the largest prospective study that validates smoking in NSCLC; it shows a third of people are smoking at the time of diagnosis. Smokers have lower 12-month survival than never and ex -smokers. Quitting smoking was associated with 25% reduction in mortality which may be clinically important although not statistically significant, after adjusting for other factors.

Oxytocin differentially effects 3ß-hydroxysteroid dehydrogenase and 5α-reductase activities in prostate cancer cell lines.

It is known that oxytocin stimulates steroidogenesis in several organs by modulating activity of 3ß-hydroxysteroid dehydrogenases (HSD3B) and steroid 5α-reductases (SRD5A). However, this has not been established in prostate cancer where these enzymes, key to local production of androgens, are increased. Analysis of both HSD3B and SRD5A activities using a live cell in situ colourimetric assay demonstrated that in PC-3 cells HSD3B activity was significantly increased by oxytocin whilst SRD5A activity was unchanged. This was confirmed in ELISA based assays of conversion of pregnenolone to progesterone and testosterone to dihydrotestosterone in cell lysates following treatment. In contrast, oxytocin significantly inhibited HSD3B activity in LNCaPs, but significantly increased activity of SRD5A, as confirmed by ELISA assays. Analysis of both cell lines by microarray and qRT-PCR determined that these changes were not due to altered gene transcription. This study demonstrates differential effects of oxytocin on the activities of key de novo steroidogenic enzymes in prostate cancer cells.

A model program for perinatal palliative services.

Despite the fact that parents of infants with lethal anomalies may not want "full-blown" medical care for their infants after birth, most such infants die in neonatal intensive care units. Although neonatal nurses are trained to administer life-saving treatments, they may suffer from moral distress when faced with caring for babies with incompatible-with-life conditions. This article describes a Perinatal Comfort Care program in which (a) care is provided at the time of diagnoses/antenatally and includes home visits by members of an interdisciplinary hospice team; (b) care is collaborative, community-based, and family-centered, and takes place in labor and delivery and on the mother baby unit; and (c) follow-up to the family continues for 1 year after the death. Neonatal nurses can become involved either by initiating efforts to form a perinatal comfort care program or by joining an existing team.

Outback lift puts backs out.

While we appreciate that Barbara Woodcraft's amusing article 'Uplifting experience?' (Nursing Standard October 30) was intended as a humorous look at a serious problem, we were concerned to see that you accompanied by a photograph of two nurses performing the Australian, or Shoulder lift.