Distinct NSCLC EGFR Variants in a Family With Li-Fraumeni Syndrome: Case Report.

Introduction: Heritable lung cancer may occur in the context of germline TP53 mutations (Li-Fraumeni syndrome). Limited cases of intrafamily tumor genomic characteristics have been reported. Main concerns Important Clinical Findings Primary Diagnoses Interventions Outcomes: A 40-year-old woman with no smoking history or known environmental exposure risk was incidentally found to have stage II (T2N1) NSCLC harboring an EGFR exon 19 p.Glu746_Ala750 deletion. Family history was notable for an identical twin sister with colorectal cancer (diagnosed at age 31 y) and a mother with stage I NSCLC harboring an EGFR exon 21 c.2573T>G (p.Leu858Arg) mutation (diagnosed at age 69 y). Genetic testing revealed a germline TP53 c.542G>A (p.Arg181His) mutation in the patient, her mother, and her sister, consistent with Li-Fraumeni syndrome. No germline EGFR mutations were detected. Conclusion: Shared germline TP53 mutations may be associated with distinct NSCLC somatic EGFR mutations within families with Li-Fraumeni syndrome. Further understanding of the association between genetic cancer syndromes and lung cancer risk may improve early lung cancer detection in populations not otherwise meeting screening eligibility.

Systemic and Intracranial Efficacy of Osimertinib in EGFR L747P-Mutant NSCLC: Case Report.

Introduction: EGFR L747P mutations occur rarely, with limited preclinical research and case reports suggesting resistance to osimertinib. Main Concerns Important Clinical Findings Primary Diagnoses Interventions Outcomes: An 84-year-old white male with remote smoking history presented with bilateral pulmonary nodules and multiple subcentimeter enhancing brain lesions 2 years after receiving stereotactic radiation therapy for a left upper lobe lung adenocarcinoma. After two computed tomography-guided biopsies yielded inadequate tissue and cell-free DNA analysis identified no actionable alterations, surgical biopsy results revealed an EGFR L747P mutation. Limited case reports and preclinical data suggested that this rare mutation may be resistant to the third-generation EGFR inhibitor osimertinib and recommended use of second-generation EGFR inhibitors. Because the patient had low disease burden and there were concerns on tolerability of second-generation EGFR inhibitors, the patient was initiated on osimertinib. Treatment was well-tolerated and follow-up imaging results revealed thoracic and intracranial response to therapy, which has been sustained 6 months after treatment initiation. Conclusion: Despite predicted and previously reported resistance, osimertinib may have durable efficacy against rare EGFR L747P mutations. Persistent attempts to acquire material for tumor genomic analysis may yield results critically important to clinical management.

Histologic transformation of EGFR mutant lung adenocarcinoma without exposure to EGFR inhibition.

Resistance to EGFR kinase inhibitors appears to be invariable in the treatment of non-small cell lung cancer. Several mechanisms have been described. Here, we report the first case of histologic transformation of EGFR mutant lung adenocarcinoma without prior exposure to EGFR inhibition.

Upper lip metastasis of sarcomatoid carcinoma of the lung - an unusual site of disease: a case report.

BACKGROUND: Lip metastases are rare clinical events that are frequently mistaken for other diagnoses. For sarcomatoid lung carcinoma, a rare histologic variant of non-small cell lung cancer, the incidence and pattern of cutaneous spread is poorly understood. CASE PRESENTATION: We present a case of a 79-year-old African American man with a rapidly progressive upper lip cutaneous lesion that provided the first evidence of distant metastatic spread of sarcomatoid lung carcinoma. CONCLUSIONS: This is the first reported case of lip metastasis in sarcomatoid lung carcinoma. It highlights the importance of maintaining a high level of suspicion for metastatic disease in the presence of new cutaneous findings as they may be the first evidence of advanced disease.

"They're Doing Something That Actually No One Else Can Do": A Qualitative Study of Peer Support and Primary Care Integration.

Peer support (PS) is a strategy for improving quality of care for people with chronic disease and is increasingly being integrated with primary care. We conducted semistructured qualitative interviews with 18 staff members from 4 practices that have integrated PS and primary care. From these interviews, we identified several benefits of PS and primary care integration as well as challenges to integrating and sustaining PS programs. We also identified key considerations and strategies for facilitating integration. Strategies for developing messaging to promote understanding of the unique role of peer supporters are discussed.

Effects of a Presidential Candidate's Comments on HPV Vaccine.

During and after the 2011 Republican presidential debate, a candidate questioned the safety of HPV vaccine. The authors aimed to determine the effect of these comments on parents. A national sample of 327 parents with adolescent sons ages 11-17 years completed online surveys in fall 2010 (baseline, about 1 year before the debate) and 2011 (follow-up, about 1 month after the debate). The authors used regression models to examine the association of parents' awareness of the candidate's comments with HPV vaccine initiation among their sons, their willingness to get sons free HPV vaccine, and their beliefs about potential harms of HPV vaccine. Overall, 17% of parents reported hearing about the Republican presidential candidate's comments about HPV vaccine. Parents aware of the comments had a larger increase between baseline and follow-up in the belief that HPV vaccine might cause short-term health problems compared with parents who were not aware. Although the candidate's comments may have increased some parents' beliefs about the short-term harms of HPV vaccine, the comments had no effect on other beliefs, willingness to vaccinate, or behavior. Having accurate information about HPV vaccine that is readily available to the public during such controversies may diminish their effect.

Emotional support for diabetes management: an international cross-cultural study.

PURPOSE: The purpose of this study was to explore how emotional support emerged in interactions between peer supporters (PSs) and adults living with type 2 diabetes. METHODS: Qualitative data were analyzed from 22 semistructured interviews with PSs in 3 settings: low-income Latinos in Chicago, middle-class Caucasians in the United Kingdom, and low-income African American women in North Carolina. Emotional support was defined as expressions of empathy, trust, and caring. RESULTS: Across all sites, emotional support gradually emerged over time, was often combined with informational support, and was conveyed both implicitly (through nonverbal actions connoting emotional acceptance; eg, a walk together without discussion of problems) and explicitly (eg, by reassurance or discussion of stressors). Cross-site differences did appear regarding the strategies to address barriers to diabetes management (eg, PSs in North Carolina and Chicago reported providing support for social stressors) and the role of PSs (eg, PSs in Chicago reported providing directive support). CONCLUSIONS: Across different settings and populations, emotional support for diabetes management evolved over time, was often integrated with informational support, and emerged through both implicit and explicit strategies that addressed varied context-specific stressors.

Parents' and sons' beliefs in sexual disinhibition after human papillomavirus vaccination.

BACKGROUND: The concern that adolescent girls who receive human papillomavirus (HPV) vaccine may be more likely to have sex (ie, sexual disinhibition) has been commonplace in media coverage, but this belief is not held by many parents of adolescent girls. Because no studies have addressed this topic for adolescent boys, we examined parents' and their adolescent sons' beliefs in sexual disinhibition occurring after boys receive HPV vaccine. METHODS: A national sample of parents of adolescent boys (n = 547) and their sons (aged 15-17 years; n = 176) completed online surveys in fall 2010. We used multi-item scales to measure parents' and sons' beliefs in sexual disinhibition after HPV vaccination. We used multivariate linear regression to identify correlates of beliefs in sexual disinhibition. RESULTS: Less than a quarter of parents or sons agreed with statements suggesting that HPV vaccination leads to sexual disinhibition among adolescent boys (range, 20%-24%). Parents who had more liberal political affiliations (ß = -0.11), had a daughter who had received HPV vaccine (ß = -0.12), or had no daughter (ß = -0.10) reported weaker beliefs in sexual disinhibition. Parents who reported higher anticipated regret if their sons got HPV vaccine and fainted (ß = 0.18) indicated stronger beliefs in sexual disinhibition. Sons who perceived higher peer acceptance of HPV vaccination (ß = 0.44) or were Hispanic (ß = 0.21) had stronger beliefs in sexual disinhibition. CONCLUSIONS: Most parents and sons did not believe that HPV vaccination leads to sexual disinhibition among boys. Understanding the characteristics of parents and sons who hold these beliefs may help inform efforts to increase HPV vaccine uptake among boys.

Development and validation of the smoking abstinence expectancies questionnaire.

INTRODUCTION: Despite evidence that expectancies influence the use and effects of drugs, there are no questionnaires that assess abstinence expectancies among smokers. Such a questionnaire may assist prediction models of successful quitting, enable clinicians to target specific expectancies, and give researchers a broader understanding of cognitive processes that influence smoking. METHODS: We aimed to develop a questionnaire that assesses, among daily smokers, expected short-term psychological and physiological consequences to (hypothetically) abstaining from smoking. Initial scale items, completed by 326 smokers, were constructed on the basis of theory, empirical evidence, and expert review. RESULTS: The final Smoking Abstinence Expectancies Questionnaire (SAEQ) has 28 items and 4 internally consistent subscales: Negative Mood (e.g., "I would feel grouchy"), Somatic Symptoms (e.g., "My throat would feel dry"), Harmful Consequences (e.g., "I would feel like I'm dying"), and Positive Consequences (e.g., "I would feel calm"). The full scale showed good internal consistency (∝ = .86), test-retest reliability over a 2-week span (r = .82), as well as convergent and discriminant validity. CONCLUSIONS: The present study provides preliminary support for the SAEQ as a tool in smoking cessation research and treatment planning.