Society News

CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.

This year, you can expect:

• A keynote address by Anthony Fauci, MD, covering COVID-19.

• Over 88 live sessions, including panel and case-based discussions.

• Critically relevant sessions focusing on COVID-19 and cultural diversity.

• Original investigation presentations with new, unpublished science.

• Unique networking opportunities.

• Fun and interactive CHEST Games.

Register Today

Chestmeeting.chestnet.org

CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.

This year, you can expect:

• A keynote address by Anthony Fauci, MD, covering COVID-19.

• Over 88 live sessions, including panel and case-based discussions.

• Critically relevant sessions focusing on COVID-19 and cultural diversity.

• Original investigation presentations with new, unpublished science.

• Unique networking opportunities.

• Fun and interactive CHEST Games.

Register Today

Chestmeeting.chestnet.org

CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.

This year, you can expect:

• A keynote address by Anthony Fauci, MD, covering COVID-19.

• Over 88 live sessions, including panel and case-based discussions.

• Critically relevant sessions focusing on COVID-19 and cultural diversity.

• Original investigation presentations with new, unpublished science.

• Unique networking opportunities.

• Fun and interactive CHEST Games.

Register Today

Chestmeeting.chestnet.org

Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.



Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.



Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.



Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.

Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.



Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.



Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.



Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.

Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.



Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.



Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.



Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.

Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
 

Virtual Champion’s Circle Donor Lounge

The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
 

Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT

Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
 

CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT

Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!

Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST

Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
 

Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only

Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!

 

Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
 

Virtual Champion’s Circle Donor Lounge

The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
 

Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT

Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
 

CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT

Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!

Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST

Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
 

Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only

Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!

 

Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
 

Virtual Champion’s Circle Donor Lounge

The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
 

Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT

Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
 

CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT

Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!

Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST

Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
 

Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only

Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!

 

When COVID-19 hit, the AGA Research Foundation quickly announced the AGA-Takeda COVID-19 Rapid Response Research Awards to provide funding to kick-start research into the virus’ impact on the digestive tract. We’re excited to share our three award recipients with you. Read about their research projects below.

David A. Drew, PhD, and Long H. Nguyen, MD, MS, from Massachusetts General Hospital and Harvard Medical School will test their hypothesis that gut microbial communities mediate the relationship between GI symptoms and the varied clinical presentations and outcomes in patients with COVID-19. To accomplish this goal, they will jointly develop and rapidly deploy a multinational digital infrastructure for large-scale epidemiologic studies during the current global pandemic. By characterizing the GI symptoms most predictive of COVID-19 infection risk and severity, their work will offer timely insights into the ongoing pandemic and offer a foundation for further study on the effects of COVID-19 on human gut microbial communities.

Jeffrey Wade Brown from Washington University is evaluating the infective potential of the metaplastic GI foregut. For this project Dr. Brown and his team will use a novel, unique, and unpublished organoid system that propagates the features of upper GI human metaplasia in vitro to study a potential role for metaplasia in the predisposition to COVID-19. Dr. Brown hopes this research will directly help by making a previously naive population know that they are potentially at higher risk. Further, the high-throughput screening technology they are developing will not only be useful here but also could quickly be adapted to other pandemics.

Congratulations to Drs. David A. Drew, Long H. Nguyen, and Jeffrey Wade Brown — recipients of our AGA-Takeda COVID-19 Rapid Response Research Awards from the AGA Research Foundation.

[email protected]

When COVID-19 hit, the AGA Research Foundation quickly announced the AGA-Takeda COVID-19 Rapid Response Research Awards to provide funding to kick-start research into the virus’ impact on the digestive tract. We’re excited to share our three award recipients with you. Read about their research projects below.

David A. Drew, PhD, and Long H. Nguyen, MD, MS, from Massachusetts General Hospital and Harvard Medical School will test their hypothesis that gut microbial communities mediate the relationship between GI symptoms and the varied clinical presentations and outcomes in patients with COVID-19. To accomplish this goal, they will jointly develop and rapidly deploy a multinational digital infrastructure for large-scale epidemiologic studies during the current global pandemic. By characterizing the GI symptoms most predictive of COVID-19 infection risk and severity, their work will offer timely insights into the ongoing pandemic and offer a foundation for further study on the effects of COVID-19 on human gut microbial communities.

Jeffrey Wade Brown from Washington University is evaluating the infective potential of the metaplastic GI foregut. For this project Dr. Brown and his team will use a novel, unique, and unpublished organoid system that propagates the features of upper GI human metaplasia in vitro to study a potential role for metaplasia in the predisposition to COVID-19. Dr. Brown hopes this research will directly help by making a previously naive population know that they are potentially at higher risk. Further, the high-throughput screening technology they are developing will not only be useful here but also could quickly be adapted to other pandemics.

Congratulations to Drs. David A. Drew, Long H. Nguyen, and Jeffrey Wade Brown — recipients of our AGA-Takeda COVID-19 Rapid Response Research Awards from the AGA Research Foundation.

[email protected]

When COVID-19 hit, the AGA Research Foundation quickly announced the AGA-Takeda COVID-19 Rapid Response Research Awards to provide funding to kick-start research into the virus’ impact on the digestive tract. We’re excited to share our three award recipients with you. Read about their research projects below.

David A. Drew, PhD, and Long H. Nguyen, MD, MS, from Massachusetts General Hospital and Harvard Medical School will test their hypothesis that gut microbial communities mediate the relationship between GI symptoms and the varied clinical presentations and outcomes in patients with COVID-19. To accomplish this goal, they will jointly develop and rapidly deploy a multinational digital infrastructure for large-scale epidemiologic studies during the current global pandemic. By characterizing the GI symptoms most predictive of COVID-19 infection risk and severity, their work will offer timely insights into the ongoing pandemic and offer a foundation for further study on the effects of COVID-19 on human gut microbial communities.

Jeffrey Wade Brown from Washington University is evaluating the infective potential of the metaplastic GI foregut. For this project Dr. Brown and his team will use a novel, unique, and unpublished organoid system that propagates the features of upper GI human metaplasia in vitro to study a potential role for metaplasia in the predisposition to COVID-19. Dr. Brown hopes this research will directly help by making a previously naive population know that they are potentially at higher risk. Further, the high-throughput screening technology they are developing will not only be useful here but also could quickly be adapted to other pandemics.

Congratulations to Drs. David A. Drew, Long H. Nguyen, and Jeffrey Wade Brown — recipients of our AGA-Takeda COVID-19 Rapid Response Research Awards from the AGA Research Foundation.

[email protected]

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP