News from Dec. 16, 2014 Annals of Internal Medicine

Racial disparities in colon cancer survival rates may be explained by overall health at the time of diagnosis rather than differences in treatment received, according to a study published in Annals of Internal Medicine. Colon cancer is the fourth-most common cancer in the United States. Black patients have higher incidence of colon cancer than white patients and are more likely to die from the disease. Researchers sought to determine the extent to which differences in overall health at diagnosis or differences in treatment could explain this disparity in survival. A total of 7,677 black patients with colon cancer were sequentially matched with three groups of white patients. Patients were matched first by demographic characteristics, then presentation (overall health including tumor size and comorbid conditions), and then treatment. The researchers found that treatment differences accounted for only a very small percentage of the overall racial disparity in 5-year survival. Most of the disparity in survival is explained by poorer health of black patients at diagnosis, with black patients presenting with more advanced disease and more comorbid conditions.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Dana Weidig at weidigd@email.chop.edu or

267-426-6092.

Emphysema-like lung found on computed tomography (CT) is associated with an increased risk for mortality among people without airflow obstruction or COPD, according to a study published in Annals of Internal Medicine. Emphysema was originally diagnosed on autopsy but is also a common "incidental" finding on chest CT done for other reasons. Reduced lung function is known to be associated with increased all-cause mortality and persons with COPD and CT-detected emphysema are known to have worse outcomes. However, the prognostic significance of emphysema on CT among patients without COPD is unknown. Researchers followed 2,965 patients who had no COPD on spirometry for six years. They found that emphysema-like lung assessed quantitatively on CT is associated with increased all-cause mortality and, therefore, is a clinically important finding.

Note: The URL will be live when the embargo lifts. For a PDF of the study, please contact Megan Hanks. To interview the lead author, please contact Lucky Tran at lt2549@columbia.edu or

212-305-3689.

The purpose for which personal medical data is being used may be just as important as consent, according to a survey published in Annals of Internal Medicine. Patient-level health information has substantial value across a range of uses and is becoming more widely available as use of electronic health records (EHR) increases. As such, there has been considerable debate about patient consent. Some argue that health data should not be used without consent and others argue that consent for every use is infeasible and that a blanket opt-in should be employed. The rationale is that patients may have some obligation to share information for socially beneficial purposes. Researchers surveyed 3,064 people to examine public support for secondary uses of electronic health information under different types of consent agreements. Survey participants were presented with hypothetical scenarios of different uses of patient data. For each scenario, the purpose for which data were used varied, as did the level of detail provided and whether consent was obtained. Responses were complex and indicate that obtaining consent is important, but the purpose of the use of health information is also important. The authors suggest that social value of the information being used may need to be emphasized.

A related commentary also published in Annals of Internal Medicine discusses the recent publication of a study conducted by Facebook without participant consent. The article examines the ethics of corporate research with regard to consent as more and more information is shared online.

Note: The URL will be live when the embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author of the survey article, please contact Anna Duerr at anna.duerr@uphs.upenn.edu or 215-349-8369. To reach the lead author of the commentary, please contact Lucky Tran at lt2549@columbia.edu or 212-305-3689.

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