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M.A. Steliga



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    MS07 - Epidemiology and Prevention (ID 24)

    • Event: WCLC 2013
    • Type: Mini Symposia
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      MS07.1 - Successful Tobacco Control Approaches in the 21st Century (ID 486)

      14:00 - 15:30  |  Author(s): M.A. Steliga

      • Abstract
      • Presentation
      • Slides

      Abstract

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    O06 - Cancer Control and Epidemiology I (ID 135)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      O06.03 - DISCUSSANT (ID 4002)

      10:30 - 12:00  |  Author(s): M.A. Steliga

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P3.23 - Poster Session 3 - Tobacco Control, Prevention and Chemoprevention (ID 164)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P3.23-003 - Implementation of a tobacco treatment program within a multidisciplinary thoracic oncology surgery clinic (ID 1985)

      09:30 - 16:30  |  Author(s): M.A. Steliga

      • Abstract

      Background
      Many patients in a multidiscipinary thoracic oncology surgery clinic smoke, and are treated for diseases related to smoking. While some patients may be former smokers, many are actively smoking and unable to quit. In the short term, perioperative complications such as impaired wound healing, and increased respiratory complications are linked to continued tobacco use whereas long term survival may be impacted by smoking causing increased cardiovascular risk, worsening emphysema and future development of metachronous primary tumors. Although quitting smoking has proven health benefits, nicotine addiction is one of the most challenging to overcome leading to a nihilistic view of tobacco cessation in this setting by some patients and clinicians. Unaided cessation has a poor success rate (<5%), while a combination of physician recommendation, face to face counseling by certified tobacco treatment specialists (TTS), individualized pharmacotherapy and ongoing follow up can improve quit rates and tobacco abstinence.

      Methods
      A multidisciplinary team from thoracic surgery, the college of nursing and the college of health professions was assembled with the goal of providing multifaceted, evidence-based tobacco treatment as an integrated part of our thoracic oncology surgery clinic. Three team members obtained TTS training. After institutional board review approval, all clinic patients were queried for tobacco use, and any patient actively smoking underwent brief intervention by the thoracic surgeon (who is a TTS) and was referred for more in depth counseling to another member of the team who is also a TTS. For patient convenience, and increased compliance with referral to cessation services, the counseling took place in clinic, in a private conference room adjacent to the exam rooms. Demographic data, tobacco use data, other drug/alcohol use and medication use data were recorded prospectively in a database. Follow up visits were conducted in the inpatient setting, upon return to clinic and/or contact via phone. Exhaled breath carbon monoxide monitoring was used during the visits to confirm initial active use and also used to confirm successful cessation.

      Results
      Over the initial seven months, 60 patients were identified as active smokers. All received brief intervention by the surgeon and referral to the quitline and in-clinic TTS counselor. Despite physician recommendation, the free of charge service, and the convenience of the service in clinic, 23/60 patients refused to meet the TTS counselor. Of the patients (24/60) who agreed to meet with the TTS, consented to enroll in the program, and agreed to follow up contact, 17/24 (70.8%) quit and remained abstinent at last contact (between 1-6 month follow up). Some patients did not meet inclusion criteria yet still met with the TTS counselor for referral to the quitline, or to talk about continued abstinence after quitting.

      Conclusion
      Integrating TTS in the multidisciplinary thoracic oncology surgery clinic can be accomplished. For those that enroll and consent to follow up, this pilot data demonstrates excellent short-term quit rates in this setting. Ongoing enrollment, further follow up, and planned expansion to involve other clinics (pulmonary and medical oncology) will allow better understanding of the efficacy of tobacco cessation services integrated into clinical settings.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-052 - Myxoid mesenchymal neoplasm presenting as massive arm and chest wall edema with pleural effusion (ID 3401)

      09:30 - 16:30  |  Author(s): M.A. Steliga

      • Abstract

      Background
      not applicable

      Methods
      Figure 1 This patient is a 50-year-old Hispanic woman who had been diagnosed with idiopathic edema of the right upper extremity and chest wall which progressed gradually over the last 8 years. Over the last year and-a-half, she has developed dyspnea on exertion with occasional cough. She has occasional right chest wall discomfort, but no abdominal pain. She has arm and back pain from the massive swelling. She has no GI complaints with the exception of nausea after meals. She has no lower extremity edema, no fever, chills or sweats. During our evaluation she was found to have massive right-sided pleural effusion.

      Results
      Figure 1 Biopsies of the pleura , soft tissues, and skin showed a myxoid mesenchymal neoplasm. Brain MRI showed no intracranial or meningeal masses. Her pleural fluid was most consistent with exudate. Cultures and cytology was negative. Glucose in the pleural fluid was not decreased. Triglycerides in the pleural fluid were 21 mg/dL.

      Conclusion
      This is an unsual case of a soft tissue sarcoma with significant swelling of the entire arm and ipsilateral chest with metastasis to the pleura. She had previously been diagnosed with idiopathic lymphededma and treated for that for years. The swelling was likely not due to lymphatic obstruction but rather due to slow progressive growth of the myxoid mesenchymal neoplasm. Earlier definitive diagnosis could have led to potential surgical resection, but with the massive involvement of her entire right arm, and ispilateral hemithorax, supportive care and systemic chemotherapy are the only treatment options.