Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

BACKGROUND: Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the Asian American, Native Hawaiian, or Pacific Islander community, prior studies in cervical cancer have considered this group in aggregate. OBJECTIVE: We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated Asian American, Native Hawaiian, or Pacific Islander groups. STUDY DESIGN: Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer were retrospectively analyzed. Asian American, Native Hawaiian, or Pacific Islander patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus nonmetastatic disease at diagnosis. RESULTS: Out of 122,926 patients with cervical cancer, 5142 (4.2%) identified as Asian American, Native Hawaiian, or Pacific Islander. Compared to non-Hispanic White patients, pooled Asian American, Native Hawaiian, or Pacific Islander patients presented at lower stages of cancer (non-Hispanic White: 58.7% diagnosed local/regional, Asian American, Native Hawaiian, or Pacific Islander : 85.6% at local/regional, χ2 P<.001). The largest Asian American, Native Hawaiian, or Pacific Islander subgroups included Filipino Americans (n=1051, 20.4% of Asian American, Native Hawaiian, or Pacific Islander), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. Asian American, Native Hawaiian, or Pacific Islander disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (adjusted odds ratio 1.58, 95% confidence interval 1.21-2.06, P=.001) relative to non-Hispanic White patients. Conversely, Chinese American (adjusted odds ratio 0.47, 95% confidence interval 0.37-0.59, P<.001), Vietnamese American (adjusted odds ratio 0.54, 95% confidence interval 0.41-0.70, P<.001), Hmong American (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.97, P=.040), and Indian/Pakistani American (adjusted odds ratio 0.76, 95% confidence interval 0.61-0.94, P=.013) patients were less likely to present with metastatic disease. Compared to the largest Asian American, Native Hawaiian, or Pacific Islander group (Chinese American), 9 other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (adjusted odds ratio 3.44, 95% confidence interval 2.41-4.91, P<.001), Thai American (adjusted odds ratio 2.79, 95% confidence interval 1.41-5.53, P=.003), Kampuchean American (adjusted odds ratio 2.39, 95% confidence interval 1.29-4.42, P=.006), Native Hawaiian American (adjusted odds ratio 2.23, 95% confidence interval 1.37-3.63, P=.001), and Laotian American (adjusted odds ratio 2.02, 95% confidence interval 1.13-3.61, P=.017). In contrast, Vietnamese American (adjusted odds ratio 1.20, 95% confidence interval 0.85-1.71, P=.303), and Hmong American (adjusted odds ratio 1.09, 95% confidence interval 0.50-2.37, P=.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients. CONCLUSION: Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger Asian American, Native Hawaiian, or Pacific Islander population-including Pacific Islander American and Thai American patients-may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community-based disaggregated research and tailored interventions is necessary to close these gaps.

Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines.

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.

Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward.

Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.

Nanomedicine and nanoparticle-based delivery systems in plastic and reconstructive surgery.

BACKGROUND: Nanotechnology and nanomedicine are rising novel fields in plastic and reconstructive surgery (PRS). The use of nanomaterials often goes with regenerative medicine. Due to their nanoscale, these materials stimulate repair at the cellular and molecular levels. Nanomaterials may be placed as components of nanocomposite polymers allowing enhancement of overall biochemical and biomechanical properties with improved scaffold properties, cellular attachment, and tissue regeneration. They may also be formulated as nanoparticle-based delivery systems for controlled release of signal factors or antimicrobials, for example. However, more studies on nanoparticle-based delivery systems still need to be done in this field. Nanomaterials are also used as frameworks for nerves, tendons, and other soft tissues. MAIN BODY: In this mini-review, we focus on nanoparticle-based delivery systems and nanoparticles targeting cells for response and regeneration in PRS. Specifically, we investigate their roles in various tissue regeneration, skin and wound healing, and infection control. Cell surface-targeted, controlled-release, and inorganic nanoparticle formulations with inherent biological properties have enabled enhanced wound healing, tumor visualization/imaging, tissue viability, and decreased infection, and graft/transplantation rejection through immunosuppression. CONCLUSIONS: Nanomedicine is also now being applied with electronics, theranostics, and advanced bioengineering technologies. Overall, it is a promising field that can improve patient clinical outcomes in PRS.

Survival times of patients with glioblastoma in low- and middle-income countries: a systematic review and meta-analysis.

Little is known about the survivorship of glioblastoma (GBM) patients in low- and middle-income countries (LMICs). We hypothesize that this would be lower than published figures for high-income countries due to cancer health disparities. We performed a systematic review and meta-analysis to estimate the median overall survival (OS) of GBM in LMICs and determine factors affecting OS. A systematic review of 12 electronic databases was conducted according to PRISMA guidelines to identify studies of newly diagnosed adult GBM patients done in countries classified as LMIC by the World Bank (WB) from inception to December 2020. Random effects meta-analysis of collected median overall survival data was done. Subgroup analysis and meta-regression were done to determine if WB income classification (WBIC), start year of recruitment (pre- or post-popularization of the standard Stupp protocol), and treatment modality affected OS. The 24 articles (n = 2,552) that met the inclusion criteria were from 8 low-middle income and upper-middle income countries, with 0 articles from low-income countries. Random effects analysis of 24 studies showed a pooled median OS of 14.17 months (95% CI 12.90-15.43, I2 = 79). Subgroup analysis showed a significant difference (p < 0.05) in the pooled median OS of studies predating Stupp protocol (12.54 mo, 95% CI 11.13-13.96, I2 = 80%; n = 1027) and studies postdating Stupp protocol (15.64 mo, 95% CI 13.58-17.69, I2 = 77; n = 1412). Subgroup analysis of WBIC and treatment modalities did not show significant differences. Published data on the survivorship of GBM patients in LMICs is sparse, highlighting the need for good quality pragmatic studies from LMICs. The limited evidence suggests improving survivorship after introduction of the Stupp protocol.