Survival inequity in vulnerable populations with early-stage hepatocellular carcinoma: a United States safety-net collaborative analysis

BackgroundAccess to health insurance and curative interventions [surgery/liver-directed-therapy (LDT)] affects survival for early-stage hepatocellular carcinoma (HCC). The aim of this multi-institutional study of high-volume safety-net hospitals (SNHs) and their tertiary-academic-centers (AC) was to identify the impact of type/lack of insurance on survival disparities across hospitals, particularly SNHs whose mission is to minimize insurance related access-to-care barriers for vulnerable populations.MethodsEarly-stage HCC patients (2012–2014) from the US Safety-Net Collaborative were propensity-score matched by treatment at SNH/AC. Overall survival (OS) was the primary outcome. Multivariable Cox proportional-hazard analysis was performed accounting for sociodemographic/clinical parameters.ResultsAmong 925 patients, those with no insurance (NI) had decreased curative surgery, compared to those with government insurance (GI) and private insurance [PI, (PI-SNH:60.5% vs. GI-SNH:33.1% vs. NI-SNH:13.6%, p < 0.001)], and decreased median OS (PI-SNH:32.1 vs. GI-SNH:22.8 vs. NI-SNH:9.4 months, p = 0.002). On multivariable regression controlling for sociodemographic/clinical parameters, NI-SNH (HR:2.5, 95% CI:1.3–4.9, p = 0.007) was the only insurance type/hospital system combination with significantly worse OS.ConclusionNI-SNH patients received less curative treatment than other insurance/hospitals types suggesting that treatment barriers, beyond access-to-care, need to be identified and addressed to achieve survival equity in early-stage HCC for vulnerable populations (NI-SNH).     

Radiation and immunotherapy: a synergistic combination

Immunotherapy can be an effective treatment for metastatic cancer, but a significant subpopulation will not respond, likely due to the lack of antigenic mutations or the immune-evasive properties of cancer. Likewise, radiation therapy (RT) is an established cancer treatment, but local failures still occur. Clinical observations suggest that RT may expand the therapeutic reach of immunotherapy. We examine the immunobiologic and clinical rationale for combining RT and immunotherapy, two modalities yet to be used in combination in routine practice. Preclinical data indicate that RT can potentiate the systemic efficacy of immunotherapy, while activation of the innate and adaptive immune system can enhance the local efficacy of RT.     

印度某医疗中心机械性眼外伤患者受伤情况分析

目的:研究农村转诊中心到访以病人机械性眼损伤模式.方法:本研究在Dr.Rajendra Prasad Government Medical College(RPGMC),Kangra(Himachal Pradesh)眼科进行.研究从2013-01-01/2013-12-31,周期12mo,包括数据收集、整理、描述、分析和解释,然后进行为期1 mo的随访.前瞻性研究,包括200例机械性眼损伤的患者,所有患者都接受了问卷调查,并进行详细的眼部检查.根据国际眼损伤类型分为开放性眼球损伤和闭合性眼部损伤.受损的眼睑、泪腺以及颅神经麻痹视为独立存在,通过MS Excel 2007表格使用Epi info7软件进行数据分析.结果:在研究期间,共接收门诊患者21710例,其中200例为机械性眼损伤,占门诊总人数的0.921%.患者年龄为1~80(平均33.12±20.48)岁.151(75.5%)例男性,49(24.5%)例女性患者,男女比例为3:1.200例受试者中,眼部损伤情况分别为:家中(100眼)、运动场所(29眼)、职业损伤(29眼)、道路交通事故(38眼)、暴力冲突(10眼)、学校(3眼)、宗教场所踩踏事故(1眼).就诊时视力达到6/12的有47%,<6/12~6/36有13.5%,<6/36~1/60有6%,<1/60~光感有22%,无光感的4%.7.5%患者视力无法通过国际标准视力表评估.大多数患者为闭合性眼部损伤(54.5%),涉及眼睑、泪腺(23%),开放性眼部损伤为19.5%,3%累及颅神经.结论:眼部机械性损伤是造成单眼失明的常见病因,具有可预防性.