Background & Aim Dendritic cells (DC) have the capacity to induce potent tumor antigen-specific T-cell immunity. We have completed vaccination in the adjuvant setting in 77 cancer patients (acute myeloid leukemia (AML, n=30), metastatic breast cancer (MBC, n=12), glioblastoma multiforme (GBM, n=13), malignant pleural mesothelioma (MPM, n=10) and other solid tumors (n=12)) with autologous DC electroporated with mRNA encoding the nearly universal tumor-associated antigen Wilms’ tumor 1 protein (WT1). Methods, Results & Conclusion WT1-targeted DC vaccination was feasible and safe in all patients. The majority of the patients showed a positive delayed type hypersensitivity (DTH) response to the vaccine. Objective clinical responses were observed among all tumor types, including complete (CR) and/or molecular remissions or stable disease (SD) in the AML group, partial responses (PR) and SD in the GBM group and SD in the MBC and MPM groups. In AML patients in first CR, median overall survival (OS) calculated from time of diagnosis was 56.1 months (mo). Median OS from time of diagnosis of metastasis was 41.9 mo in MBC, 43.7 mo from diagnosis in GBM and 35.7 mo from start of therapy in MPM; this compares favorably to numbers reported in the literature, respectively 24.8 mo, 14.7 mo and 22 mo. In AML, long-term OS was correlated with WT1-specific polyfunctional CD8+ T-cells in the DTH reaction sites and long-term CR with polyepitope WT1-specific tetramer+ CD8+ T-lymphocytes. In solid tumors, PR or SD was correlated with interferon (IFN)-gamma+ and/or tumor necrosis factor (TNF)-alpha+ WT1-specific CD4+ and/or CD8+ T-cells; increased OS in the GBM+MPM cohorts was correlated with IFN-gamma+ WT1-specific CD4+ T-lymphocytes. In conclusion, WT1-targeted DC vaccination is feasible, safe and immunogenic, and displays relevant anti-tumor activity in patients with hematological and solid malignancies. Most importantly, this treatment modality can confer a significant survival benefit to the patients. Dendritic cells (DC) have the capacity to induce potent tumor antigen-specific T-cell immunity. We have completed vaccination in the adjuvant setting in 77 cancer patients (acute myeloid leukemia (AML, n=30), metastatic breast cancer (MBC, n=12), glioblastoma multiforme (GBM, n=13), malignant pleural mesothelioma (MPM, n=10) and other solid tumors (n=12)) with autologous DC electroporated with mRNA encoding the nearly universal tumor-associated antigen Wilms’ tumor 1 protein (WT1). WT1-targeted DC vaccination was feasible and safe in all patients. The majority of the patients showed a positive delayed type hypersensitivity (DTH) response to the vaccine. Objective clinical responses were observed among all tumor types, including complete (CR) and/or molecular remissions or stable disease (SD) in the AML group, partial responses (PR) and SD in the GBM group and SD in the MBC and MPM groups.

Objectives: Military personnel are considered at risk of exposure to acute acoustic trauma (AT) and potential noise-induced hearing loss (NIHL). This study aimed to profile the Belgian military to determine risk factors for AT and objective hearing loss after AT. Methodology: This retrospective cohort included 192 members of the Belgian Defense Forces that had sustained ATs from 2013 to 2017. The main cohort included military personnel admitted to the military hospital after an AT. Subgroup 1 included those with objective hearing loss within one week after the AT; subgroup 2 included patients with objective hearing loss that persisted for 6 weeks. Potential risk and prognostic factors were analyzed with logistic regression. Results: The at-risk population susceptible to developing an AT (main cohort) were mostly young volunteers (49%) with a mean age of 26 years and a mean seniority of 5.4 years. These individuals were in training (66%), using rifles and submachine guns (70%), and were active in the land force (71%). Military staff that did not wear adequate hearing protective devices, those that had finished training, and those with high seniority were at increased risk of objective hearing loss within 1 week after an AT. Conclusion: Demographic and environmental factors that increased the risk of exposure to an AT differed from factors associated with objective hearing loss after an AT. Therefore, these different demographic profiles can be of great importance in military hearing protection campaigns.

A reduction in ambient pressure or decompression from scuba diving can result in ultrasound-detectable venous gas emboli (VGE). These environmental exposures carry a risk of decompression sickness (DCS) which is mitigated by adherence to decompression schedules; however, bubbles are routinely observed for dives well within these limits and significant inter-personal variability in DCS risk exists. Here, we assess the variability and evolution of VGE for 2 h post-dive using echocardiography, following a standardized pool dive in calm warm conditions.

Introduction A multicenter study was performed in Belgium to establish an optimal workflow for liquid biopsy, consisting of circulating cell-free tumour DNA (ctDNA) analysis. Material and methods EGFR ctDNA mutational analysis was performed on 549 plasma samples from 234 non-small cell lung cancer (NSCLC) patients. The influence of (pre-) analytical variables on concentration, allele frequency (AF) and sensitivity were investigated. These variables include centrifugation, transit time, temperature and the presence of brain (BM) and extra thoracic metastases (ETM). Results and discussions Sensitivity of ctDNA analysis is influenced by an interplay between increased plasma volume (p<0.001) and short transit time (p=0.018). Multistep, high-speed centrifugation both increases plasma generation (p<0.001), and reduces genomic DNA (gDNA) contamination. A longer transit time also increases the risk of hemolysis (p<0.001), which has a negative influence on sensitivity (p=0.047). Temperatures below 10°C were also shown to have a negative effect. The presence of ETM was found to be strongly associated with ctDNA detection (p<0.001), as well as AF (p=0.034). The concentration and AF in these patients were also significantly higher compared to patients in whom only BM were present. Furthermore, the original activating mutations were always detected in a higher concentration and AF than the T790M mutation (p=0.003, and p=0.002, respectively). Conclusion Optimisation of (pre-) analytical variables is key to successful ctDNA analysis. Sufficient plasma volumes without hemolysis or gDNA contamination can be achieved by using multistep, high speed centrifugation coupled with short transit time and precautions in case of low temperatures. Deviating pre-analytical variables, low levels of ctDNA in the circulation due to BM and no ETM, might hinder ctDNA detection. In case of using liquid biopsy as a tool to detect resistance, the detection of low AF of the original activating mutation without the T790M resistance mutation might be indicative of low ctDNA levels in the circulation. If clinically possible, a new liquid biopsy in a few weeks might reveal the T790M mutation. A tissue biopsy is advisable in case of either no detectable ctDNA or high AF of the original activating mutation alone. The detection of the T790M mutation in the ctDNA is sufficient to initiate osimertinib therapy. In this study, an optimised workflow for liquid biopsy has been established which might aid in a further standardisation and implementation in clinical practice.

ENT indications for Hyperbaric Oxygen Therapy. Hyperbaric Oxygen (HBO) therapy is a treatment where patients breathe 100% oxygen while exposed to high environmental pressure in a hyperbaric chamber. This hyperoxygenation has several beneficial effects as an adjunctive treatment in a number of ENT-related conditions and diseases. These can be summarized as anti-ischaemic effects (delivery of oxygen to otherwise ischaemic tissues, reduction of ischaemia-reperfusion damage), anti-infectious effects (bacteriostasis, improved leucocyte phagocytosis bactericidal activity and optimization of antibiotic therapy) and wound-healing effects (stimulation of granulation tissue formation and stabilization). Since HBO therapy has a clear physiologic rationale, a demonstrated effect (although difficult to "prove" with placebo controlled randomized trials) in certain indications and certain side-effects, it is proposed that it should be considered an integral part of the (combined surgical and pharmacological) treatment of patients, and not simply as a supplementation of oxygen. Furthermore, the importance of a well-trained medical and technical staff to ensure proper selection and the correct follow-up of patients should not be underestimated.

Although many factors contributing to inert gas narcosis onset and severity have been put forward, the available evidence is not particularly strong. Using objective criteria, we have assessed brain impairment associated with narcosis under various environmental diving conditions. 40 volunteers performed a no-decompression dive (33 m for 20 min) either in a dry chamber, a pool or open sea. They were assessed by critical flicker fusion frequency before the dive, upon arriving at depth, 5 min before ascent, on surfacing and 30 min post-dive. Compared to the pre-dive value, the mean value of each measurement was significantly different. An increase of flicker fusion to 105.00 +/- 0.69 % when arriving at depth is followed by a decrease to 94.05 +/- 0.65 %. This impairment persists when surfacing and 30 min post-dive, decreasing further to 96.36 +/- 0.73 % and 96.24 +/- 0.73 %, respectively. Intragroup comparison failed to demonstrate any statistical difference. When objectively measured narcosis may not be influenced by external factors other than pressure and gas. This might be of importance for training to avoid any over-or underestimation of the severity of narcosis based only on subjective symptoms.

The organs of the ear, nose and throat (ENT) contain air- or gas-filled cavities, which make them sensitive to pressure changes. There is a specific pathophysiology involved when these structures are exposed to non-acoustic press ure changes, which are usually not traumatic in normals. The concepts of pathophysiology, diagnosis and treatment of these traumas in an emergency setting are reviewed.

We have previously reported the clinical and immunological effects of vaccination with dendritic cells electroporated with WT1 mRNA (WT1/DC) in 10 patients with acute myeloid leukemia (AML) (Van Tendeloo et al. PNAS 2010). In the present study, we expanded on the initial results and investigated WT1/DC as an adjuvant treatment in 60 high-risk cancer patients.

BACKGROUNDThis multicentre, open-label, randomized, controlled phase II study evaluated cilengitide in combination with cetuximab and platinum-based chemotherapy, compared with cetuximab and chemotherapy alone, as first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC).PATIENTS AND METHODSPatients were randomized 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (control), or combined with cilengitide 2000 mg 1×/week i.v. (CIL-once) or 2×/week i.v. (CIL-twice). A protocol amendment limited enrolment to patients with epidermal growth factor receptor (EGFR) histoscore ≥200 and closed the CIL-twice arm for practical feasibility issues. Primary end point was progression-free survival (PFS; independent read); secondary end points included overall survival (OS), safety, and biomarker analyses. A comparison between the CIL-once and control arms is reported, both for the total cohorts, as well as for patients with EGFR histoscore ≥200.RESULTSThere were 85 patients in the CIL-once group and 84 in the control group. The PFS (independent read) was 6.2 versus 5.0 months for CIL-once versus control [hazard ratio (HR) 0.72; P = 0.085]; for patients with EGFR histoscore ≥200, PFS was 6.8 versus 5.6 months, respectively (HR 0.57; P = 0.0446). Median OS was 13.6 for CIL-once versus 9.7 months for control (HR 0.81; P = 0.265). In patients with EGFR ≥200, OS was 13.2 versus 11.8 months, respectively (HR 0.95; P = 0.855). No major differences in adverse events between CIL-once and control were reported; nausea (59% versus 56%, respectively) and neutropenia (54% versus 46%, respectively) were the most frequent. There was no increased incidence of thromboembolic events or haemorrhage in cilengitide-treated patients. αvβ3 and αvβ5 expression was neither a predictive nor a prognostic indicator.CONCLUSIONSThe addition of cilengitide to cetuximab/chemotherapy indicated potential clinical activity, with a trend for PFS difference in the independent-read analysis. However, the observed inconsistencies across end points suggest additional investigations are required to substantiate a potential role of other integrin inhibitors in NSCLC treatment.CLINICAL TRIAL REGISTRATION ID NUMBERNCT00842712.

We investigated long‐term effects of SCUBA diving on cognitive function using a battery of neuropsychometric tests: the Simple Reaction Time (REA), Symbol Digit Substitution (SDS), Digit Span Backwards (DSB), and Hand‐Eye Coordination tests (EYE). A group (n = 44) of experienced SCUBA divers with no history of decompression sickness was compared to non‐diving control subjects (n = 37), as well as to professional boxers (n = 24), who are considered at higher risk of long term neurological damage. The REA was significantly shorter in SCUBA divers compared to the control subjects, and also more stable over the time course of the test. In contrast, the number of digits correctly memorized and reordered (DSB) was significantly lower for SCUBA divers compared to the control group. The results also showed that boxers performed significantly worse than the control group in three out of four tests (REA, DSB, EYE). While it may be concluded that accident‐free SCUBA diving may have some long‐term adverse effects on short‐term memory, there is however, no evidence of general higher cognitive function deficiency.

ABSTRACT Aim: CIL is a selective, competitive inhibitor of avb3 and avb5 integrins designed to attack the tumour and its microenvironment. CERTO is a multicentre, controlled, open-label phase II study (NCT00842712) for pts with histologically confirmed newly diagnosed advanced NSCLC. Methods: Pts were initially randomised 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (CTRL), or combined with CIL 2000 mg 1x/week (CIL1W) or 2x/week (CIL2W). During the study, an amendment triggered by cetuximab data from the FLEX study led to enrolment only of pts with EGFR histoscore ≥200, and closure of CIL2W due to feasibility issues. Primary endpoint was progression-free survival (PFS; independent read); secondary endpoints included overall survival (OS), safety, and biomarker analyses. Results: Overall, 220 pts were randomised: 85 to CIL1W; 51 to CIL2W; and 84 to CTRL. Baseline characteristics were balanced. Median PFS (independent read, ITT) was 6.2 mo in CIL1W vs 5.0 mo in CTRL (HR 0.72 [95% CI, 0.49, 1.05]; p = 0.085). For pts with EGFR ≥200, median PFS was 6.8 mo in CIL1W vs 5.6 mo in CTRL (HR 0.57 [95% CI, 0.32, 0.99], p = 0.045). Investigator-read PFS was not different between CIL1W and CTRL in either population. Median OS was 13.6 vs 9.7 mo in CIL1W vs CTRL, respectively (ITT; HR 0.81 [95% CI, 0.56, 1.17]; p = 0.265); in pts with EGFR ≥200 no difference between CIL1W vs CTR for OS was found. Generally, no relevant differences between adverse events across treatment arms were reported; nausea (56%), neutropaenia (49%), and anaemia (37%) were the most frequent, and there was no increased incidence of thromboembolic events or haemorrhages in CIL-treated pts. Biomarker sample size was small, but avb3 and avb5 expression did not reveal a prognostic correlation to PFS or OS, and was not predictive of treatment outcome. Conclusions: A benefit for addition of CIL1W to cetuximab and chemotherapy was seen for independent-read PFS, and a HR 0.81 for OS, equivalent to a 3.9 mo median survival improvement in favour of the combination, but no consistent efficacy was shown with CIL vs CTRL. The safety profile did not reveal any safety concerns for CIL. Disclosure: J.F. Vansteenkiste: Advisory board: advisory functions for Merck-Serono; F. Barlesi: Corporate-sponsored research: Merck; J. Bennouna: Advisory Board: Roche, Boehringer Ingelheim and Novartis; E. Goekkurt: Advisory board: Merck; H. Lena: Advisory board: Merck; C. Hicking: Ownership: Stock Ownership Merck KGaA Other substantive relationships: Employee of trial sponsor; J. Straub: Other substantive relationships:: Employee of the trial Merck; M. Picard: Other substantive relationships: Employee of the trial sponsor; W. Schuette: Advisory Board: Merck, Amgen, AstraZeneca, Roche Corporate-sponsored research: Roche, Lilly, AstraZeneca, Amgen, Genentech, Daiichi Sankyo; K. O' Byrne: Advisory board: for cetuximab non small lung cancer Corporate-sponsored research: Grant received for clinical trial which was completed 5 years ago Other substantive relationships: Honoraria for speaker bureau lectures. All other authors have declared no conflicts of interest.

ObjectiveIn echocardiography, Doppler flow imaging is a conventional method to have general aspects of blood behavior within cardiac chambers. In B-mode ultrasound, contrast enhanced echocardiography would provide new features through contrast agent-blood interaction to reveal a better understanding of flow. Echo PIV is an innovative approach to reveal this interaction with contrast quantification. In this study, we aimed to measure particle properties of a saline contrast in two different cases by generating vortex patterns in left ventricle (LV) and left atrium (LA) during a cardiac cycle.MethodsContrast agent movements in blood are represented with different numerical models to quantify cardiac diseases. These movements would be denoted as vortex patterns due to systolic-diastolic contractions. In Echo PIV, these vortex patterns are the main identifiers to resolve spatio-temporal evaluation of blood within the selected chamber. In this study, both single plane and multi plane echocardiographic frames were analyzed. Two different cases; Patent Foramen Ovale (PFO) and Arrythmogenic Right Ventricle Dysplasia (ARVD) were observed to quantify velocity fields and generate the vortex patterns.ResultsIn both cases velocity fields confirmed the physical evaluation of flow. In PFO, the first frames of shunt opening described the evaluation of contrast agent-blood interaction through vortex patterns. This evaluation was performed in single plane. On the other hand, ARVD monitoring was performed through multiplanar analysis. Therefore, all vortex patterns between diastole and systole provided a complete understanding of the ventricle hemodynamics.ConclusionThe visualization of a contrast agent within cardiac chambers is a challenging task to see crucial effects of hemadynamical effects. However, the vorticity related to these effects with agent-blood interaction is generally not fully interpreted. Echo PIV provides a new way to interpret the flux regarding ultrasonic flow imaging. In this study, we studied two different cases with single and multiplanar views and concluded that Echo PIV would be a relevant analysis to explain flow velocities. ObjectiveIn echocardiography, Doppler flow imaging is a conventional method to have general aspects of blood behavior within cardiac chambers. In B-mode ultrasound, contrast enhanced echocardiography would provide new features through contrast agent-blood interaction to reveal a better understanding of flow. Echo PIV is an innovative approach to reveal this interaction with contrast quantification. In this study, we aimed to measure particle properties of a saline contrast in two different cases by generating vortex patterns in left ventricle (LV) and left atrium (LA) during a cardiac cycle. In echocardiography, Doppler flow imaging is a conventional method to have general aspects of blood behavior within cardiac chambers. In B-mode ultrasound, contrast enhanced echocardiography would provide new features through contrast agent-blood interaction to reveal a better understanding of flow. Echo PIV is an innovative approach to reveal this interaction with contrast quantification. In this study, we aimed to measure particle properties of a saline contrast in two different cases by generating vortex patterns in left ventricle (LV) and left atrium (LA) during a cardiac cycle. MethodsContrast agent movements in blood are represented with different numerical models to quantify cardiac diseases. These movements would be denoted as vortex patterns due to systolic-diastolic contractions. In Echo PIV, these vortex patterns are the main identifiers to resolve spatio-temporal evaluation of blood within the selected chamber. In this study, both single plane and multi plane echocardiographic frames were analyzed. Two different cases; Patent Foramen Ovale (PFO) and Arrythmogenic Right Ventricle Dysplasia (ARVD) were observed to quantify velocity fields and generate the vortex patterns. Contrast agent movements in blood are represented with different numerical models to quantify cardiac diseases. These movements would be denoted as vortex patterns due to systolic-diastolic contractions. In Echo PIV, these vortex patterns are the main identifiers to resolve spatio-temporal evaluation of blood within the selected chamber. In this study, both single plane and multi plane echocardiographic frames were analyzed. Two different cases; Patent Foramen Ovale (PFO) and Arrythmogenic Right Ventricle Dysplasia (ARVD) were observed to quantify velocity fields and generate the vortex patterns. ResultsIn both cases velocity fields confirmed the physical evaluation of flow. In PFO, the first frames of shunt opening described the evaluation of contrast agent-blood interaction through vortex patterns. This evaluation was performed in single plane. On the other hand, ARVD monitoring was performed through multiplanar analysis. Therefore, all vortex patterns between diastole and systole provided a complete understanding of the ventricle hemodynamics. In both cases velocity fields confirmed the physical evaluation of flow. In PFO, the first frames of shunt opening described the evaluation of contrast agent-blood interaction through vortex patterns. This evaluation was performed in single plane. On the other hand, ARVD monitoring was performed through multiplanar analysis. Therefore, all vortex patterns between diastole and systole provided a complete understanding of the ventricle hemodynamics. ConclusionThe visualization of a contrast agent within cardiac chambers is a challenging task to see crucial effects of hemadynamical effects. However, the vorticity related to these effects with agent-blood interaction is generally not fully interpreted. Echo PIV provides a new way to interpret the flux regarding ultrasonic flow imaging. In this study, we studied two different cases with single and multiplanar views and concluded that Echo PIV would be a relevant analysis to explain flow velocities. The visualization of a contrast agent within cardiac chambers is a challenging task to see crucial effects of hemadynamical effects. However, the vorticity related to these effects with agent-blood interaction is generally not fully interpreted. Echo PIV provides a new way to interpret the flux regarding ultrasonic flow imaging. In this study, we studied two different cases with single and multiplanar views and concluded that Echo PIV would be a relevant analysis to explain flow velocities.

We conducted two nonindustry biomarker-directed randomized clinical trials in advanced non-small-cell lung cancer, comparing nonselected cisplatin-based chemotherapy with therapy customized by BRCA1 and RAP80 levels: a European phase III trial and an analogous Chinese phase II trial. These trials have laid the groundwork for future research to define predictive models for chemotherapy outcome.In a Spanish Lung Cancer Group (SLCG) phase II trial, the combination of BRCA1 and receptor-associated protein 80 (RAP80) expression was significantly associated with outcome in Caucasian patients with nonsmall-cell lung cancer (NSCLC). The SLCG therefore undertook an industry-independent collaborative randomized phase III trial comparing nonselected cisplatin-based chemotherapy with therapy customized according to BRCA1/RAP80 expression. An analogous randomized phase II trial was carried out in China under the auspices of the SLCG to evaluate the effect of BRCA1/RAP80 expression in Asian patients.Eligibility criteria included stage IIIB-IV NSCLC and sufficient tumor specimen for molecular analysis. Randomization to the control or experimental arm was 1 : 1 in the SLCG trial and 1 : 3 in the Chinese trial. In both trials, patients in the control arm received docetaxel/cisplatin; in the experimental arm, patients with low RAP80 expression received gemcitabine/cisplatin, those with intermediate/high RAP80 expression and low/intermediate BRCA1 expression received docetaxel/cisplatin, and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone. The primary end point was progression-free survival (PFS).Two hundred and seventy-nine patients in the SLCG trial and 124 in the Chinese trial were assessable for PFS. PFS in the control and experimental arms in the SLCG trial was 5.49 and 4.38 months, respectively [log rank P = 0.07; hazard ratio (HR) 1.28; P = 0.03]. In the Chinese trial, PFS was 4.74 and 3.78 months, respectively (log rank P = 0.82; HR 0.95; P = 0.82).Accrual was prematurely closed on the SLCG trial due to the absence of clinical benefit in the experimental over the control arm. However, the BREC studies provide proof of concept that an international, nonindustry, biomarker-directed trial is feasible. Thanks to the groundwork laid by these studies, we expect that ongoing further research on alternative biomarkers to elucidate DNA repair mechanisms will help define novel therapeutic approaches.NCT00617656/GECP-BREC and ChiCTR-TRC-12001860/BREC-CHINA.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the recommended first-line treatment in metastatic EGFR-mutation-positive non-small cell lung cancer (NSCLC) patients. Such a personalized treatment requires fast EGFR mutation testing. This study was performed to determine the turn around time (TAT) for EGFR mutation testing on tumour samples of NSCLC in the clinical care in the region of Antwerp (Belgium). The secondary aim was to determine the frequency of EGFR mutations in this Flemish population. Tumour tissue was prospectively obtained from lung cancer patients in participating hospitals and sent from the local pathology laboratory (lab) to two central laboratories (labs) where EGFR-mutation analysis was performed. Results were returned from the central labs to the clinicians and the local pathology lab. TAT was defined as the interval between the request from the oncologist and the result obtained by the oncologist. One hundred and seven specimens were analysed. The clinician got the result from the local lab in a median time of 10 days (3-37 days) and from the central lab in 9 days (3-29 days). We detected seven mutations (7%) in this study population, all occurring in tumours with an adenocarcinoma histology, four (57%) in men and five (71%) in (ex-) smokers. There were six exon 19 deletions and one L858R mutation. It is possible to implement EGFR-mutation testing with timely reporting of the EGFR-mutation status. EGFR-mutation occurs in 7% of Flemish patients with NSCLC. Patients with advanced non-squamous NSCLC should be tested for EGFR mutation regardless of their gender and smoking history.

Purpose The objective is to explore changes over time in the information and participation preferences of newly diagnosed stage IIIb/IV non-small-cell lung cancer patients. Methods Patients were recruited by physicians in 13 hospitals and interviewed every 2 months until the fourth and every 4 months until the sixth interview. Results Sixty-seven patients were interviewed three times. Over a period of 4 months from diagnosis, half of patients changed their information preferences for palliative care and end-of-life decisions with a possible or certain life-shortening effect (ELDs, e.g., non-treatment decisions) in both directions, from not wanting to wanting the information, but also—and as much—from wanting to no longer wanting it. The latter were more likely to be in a better physical condition. Preferences for participation in medical decision making also changed: 50% to 78%, depending on the type of decision (general, treatment, transfer or ELD), changed their preference towards wanting more or less participation. Pain seemed to be a trigger for patients wanting more involvement, which contrasts with studies suggesting that patients who are more ill tend to give up more control. Conclusions Doctors should regularly ask their advanced lung cancer patients how much information and participation they want because preferences do change in unexpected ways.