Quality of cancer care among foreign‐born and US‐born patients with lung or colorectal cancer

BACKGROUND:

Disparities in care have been documented for foreign‐born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient‐reported quality and receipt of recommended care differed between US‐born and foreign‐born cancer patients.

METHODS:

The authors collected surveys and medical records for a population‐based cohort including white, Hispanic, and Asian adults (2205 US‐born and 890 foreign‐born individuals) with lung or colorectal cancer diagnosed in California from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient‐reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer, and curative surgery for stage I/II nonsmall cell lung cancer). The authors also assessed whether language explained any differences in care by nativity.

RESULTS:

Overall, 46% of patients reported excellent care, but foreign‐born patients were less likely than US‐born patients to report excellent quality of care (adjusted odds ratio [AOR], 0.80; 95% confidence interval [95% CI], 0.65‐1.00), a difference partly explained by the language of the survey, an indicator of English proficiency. Rates of recommended therapies ranged from 64% to 85%; foreign‐born patients were less likely to receive chemotherapy and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12‐0.99). Rates of other treatments did not differ significantly by nativity.

CONCLUSIONS:

Foreign‐born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States. Better coordination of care and communication regarding cancer treatments and expanded use of interpreters may lessen these disparities. Cancer 2010. © 2010 American Cancer Society.     

Ethnicity and management of colon cancer in New Zealand

BACKGROUND:

Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non‐Maori New Zealanders with colon cancer.

METHODS:

On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non‐Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status.

RESULTS:

Maori and non‐Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53‐0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23‐3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity.

CONCLUSIONS:

Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non‐Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations. Cancer 2010. © 2010 American Cancer Society.     

Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States

Purpose

Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9–10 years among adults in the United States (n = 4,938, ages 25–74).

Methods

Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work–family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.

Results

High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.

Conclusions

Interventions to address psychosocial stress may be important components within smoking cessation efforts.     

Abnormal expression of hepatoma specific gamma-glutamyl transferase and alteration of gamma-glutamyl transferase gene methylation status in patients with hepatocellular carcinoma

Abnormal expression of hepatoma specific gamma-glutamyl transferase and alteration of gamma-glutamyl transferase gene methylation status in patients with hepatocellular carcinoma@Jiang DR @Huang ZW @Lu JX @Tao QY @Yu JZ @Meng XY     

膝关节周围骨肿瘤手术的肢体康复

0　引言　膝关节周围是骨原发恶性肿瘤的好发部位 .病变组织广泛侵袭 ,切除肿瘤造成骨与软组织缺损 ,各种重建方法都需最大限度地保留膝关节功能 .如何采取早期系统的康复治疗 ,是临床骨肿瘤保肢手术的重要内容 .1　对象和方法　 1992 - 0 5 / 1999- 0 3,膝关节周围恶性骨肿瘤患者 6 4例接受保肢手术治疗 .男 38例 ,女 2 6例 ;骨肉瘤 5 2例 ,恶性骨巨细胞瘤 5例 ,尤文瘤 3例 ,母细胞瘤 2例 ,原发神经外胚层肿瘤 2例 .手术方式 :异体半关节移植术 37例 ;异体骨段移植术 16例 ;复合异体骨段的人工全膝关节表面置换术3例 ,动力旋转铰链式人工全…     

10例急性重症病毒性心肌炎的临床诊治经验

目的　分析、总结急性重症病毒性心肌炎病人的发病特点、临床诊治经验。方法　收集我院 1999年 11月～ 2 0 0 3年 4月间住院治疗的 10例急性重症病毒性心肌炎病人。男性 5例 ,女性 5例 ,年龄 18-4 7( 3 6± 10 .7)岁 ,住院 12 -2 2 ( 17.5± 3 .2 )天 ,所有诊断均符合 1999年制定的关于急性病毒性心肌炎临床诊断参考标准[1 ] 。结果　所有病人心肌酶学持续性升高 ,心脏超声提示心肌收缩、舒张功能减低。本组病例均累及心脏传导系统 ,主要表现为房室和室内传导阻滞 ( 1支或 2支 ) ,均行临时起搏器植入术 ,其中 2例更换为永久起搏器。 4例酷似心梗样心电图表现的病人冠状动脉造影检查正常。 2例患者出现严重心力衰竭、1例出现心肌心包炎、1例出现严重脑部并发症。结论　急性重症病毒性心肌炎病情危重 ,发展迅速 ,典型的临床表现和心肌损伤的客观指标为该疾病的诊断提供依据 ,应用大剂量皮质激素和必要的、紧急的血流动力学支持等治疗可以明显地改善心功能 ,挽救生命。     

二羟丙氧甲基乌嘌呤抗单纯疱疹病毒Ⅰ型的实验研究

二羟丙氧甲基鸟嘌岭(DHPG),在组织培养中对单纯疱疹病毒Ⅰ型(HSV-1)KOS株抑制50%空斑形成的浓度(IC_(50))为0.1μg/ml。DHPG与环胞苷联合应用的抗HSV活性呈协同作用;DHPG分别与无环鸟苷、酞丁安合用有相加作用。0.1和0.05%DHPG溶液滴眼对家兔实验性浅层单纯疱疹病毒角膜炎有显著治疗作用,浓度降低至0.025和0.0l%无明显疗效。对实质层型单疱角膜炎,0.1%DHPG溶液滴眼治疗有效。     

The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups

To determine whether the hospital stays are longer and charges within a given diagnosis-related group (DRG) are higher for poor patients, we examined patterns of care for patients hospitalized at the Brigham and Women's Hospital for connective-tissue disorders (DRGs 240 and 241) from 1981 to 1985. The socioeconomic characteristics of 402 patients were determined through interviews, and the severity of their illness was measured by means of a standard scale of function--the Instrumental Activities of Daily Living (IADL) scale. After excluding outliers and adjusting for DRG, we found that hospital stays were significantly longer for subgroups of patients of lower socioeconomic status, whether this was defined by occupation, education, or income (P less than 0.05 for all three). Patients of low socioeconomic status also had higher total hospital charges, although the differences were not statistically significant. The differences between patients of low socioeconomic status and those of high socioeconomic status were as great as 25 percent for length of stay and 16 percent for charges. These trends persisted after we adjusted for patients' age and sex, the severity of illness, the year of discharge, the doctor's specialty, whether the patient had a regular doctor, and whether the patient lived alone. Our results suggest that for at least some conditions, hospital care for poor patients entails longer stays and probably requires the use of more resources.