Perioperative oncolytic virotherapy to counteract surgery-induced immunosuppression and improve outcomes in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is a high fatality cancer with one of the worst prognoses in solid tumors. Most patients present with late stage, metastatic disease and are not eligible for potentially curative surgery. Despite complete resection, the majority of surgical patients will recur within the first two years following surgery. Postoperative immunosuppression has been described in different digestive cancers. While the underlying mechanism is not fully understood, there is compelling evidence to link surgery with disease progression and cancer metastasis in the postoperative period. However, the idea of surgery-induced immunosuppression as a facilitator of recurrence and metastatic spread has not been explored in the context of pancreatic cancer. By surveying the existing literature on surgical stress in mostly digestive cancers, we propose a novel practice-changing paradigm: alleviate surgery-induced immunosuppression and improve oncological outcome in PDAC surgical patients by administering oncolytic virotherapy in the perioperative period.

Successful multidisciplinary management of an asymptomatic gastrosplenic fistula in a diffuse large B cell lymphoma patient.

Gastrosplenic fistula is a rare and potentially fatal clinical entity unknown to most healthcare providers. Its diagnosis and management are challenging; and addressing it too late can have devastating consequences for patients. To increase awareness about this pathology, we hereby present a case of asymptomatic gastrosplenic fistula arising from a diffuse large B cell lymphoma in a 60-year-old Caucasian man with no significant medical history. The patient was successfully treated with open en-bloc splenectomy and partial gastrectomy. The patient was discharged from the hospital 3 days after the surgery. At 1-month postoperatively, the patient was asymptomatic and presented no complication of the surgery. He went on to finish six cycles of chemotherapy (R-EPOCH, rituximab, etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride) and achieved complete metabolic response. At 2 years after the surgery, the patient remains asymptomatic and presents no sign of disease recurrence.

Evolution of the home health care market: The expansion and quality performance of multi-agency chains.

OBJECTIVE: To examine the growth and evolution of the home health agency (HHA) market and to compare quality performance across HHA ownership categories. DATA SOURCE: Agency characteristics were extracted from Medicare cost reports and Provider of Services file. Quality of care and patient characteristics were extracted from Quality of Patient Care Star Ratings and HHA Public Use File. STUDY DESIGN: Agency- and state-level analyses were conducted to describe HHA market trends. Patient characteristics and quality measures were compared across ownership categories of interest. DATA COLLECTION/EXTRACTION METHODS: All Medicare-certified HHAs in operation, 2005-2018. PRINCIPAL FINDINGS: Over the study period, the HHA sector grew substantially, increasing from 7899 to 10 818 agencies, and chain-owned HHAs doubled in number from 903 (11.4% of all agencies) to 1841 (17.0%). In 2018, across agency types, for-profit nonchain agencies were the largest category both in the number of agencies (67.8%) and the number of Medicare enrollees served (40.7%). Additionally, for-profit nonchain agencies grew most in total number, from 4293 (54.3%) to 7337 (67.8%), while for-profit chain agencies grew most in the number of Medicare enrollees served, from 439 998 (12.9%) to 1 082 385 (28.3%). Regarding patient composition, for-profit nonchain agencies served the highest proportion of dual eligible beneficiaries (42.2%) and African-Americans (27.9%) among all agency types. Regarding quality performance, a higher star rating is significantly (P < .01) associated with chain agency status. Moreover, chain HHAs performed better on self-reported process measures, and risk-adjusted self-reported outcome measures; however, they performed worse on risk-adjusted claims-based outcome measures. These results were similar across for-profit and nonprofit chain agencies. CONCLUSION: Chains play a growing role in the home health sector. Substantial differences in geographic distribution, patient composition, and quality performance were observed between chain- and nonchain HHAs. Examining the growth and performance of multi-agency chains can help inform quality reporting and monitoring, assess payment adequacy, and facilitate greater transparency and accountability within the HHA marketplace.