Clinical Outcomes for Primary and Radiation-Associated Angiosarcoma of the Breast with Multimodal Treatment: Long-Term Survival Is Achievable

Background: The optimal management of primary angiosarcoma (PAS) and radiation-associated angiosarcoma (RAAS) of the breast remains undefined. Available data show persistently poor survival outcomes following treatment with surgery or chemotherapy alone. The objective of this study was to evaluate long-term outcomes in patients treated with multimodality therapy. Methods: Patients diagnosed with stage I–III PAS or RAAS of the breast were identified from our local tumor registry (2010–2020). Patient demographics, tumor characteristics, and treatment were collected. Primary outcomes were local recurrence (LR), distant recurrence (DR), and median overall survival (OS). A secondary outcome was pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC). Mann–Whitney U, chi-squared, or Fisher exact tests were used to analyze data. Kaplan–Meier curves compared OS for PAS and RAAS. Results: Twenty-two patients met inclusion criteria, including 11 (50%) with RAAS and 11 (50%) with PAS. Compared to PAS patients, RAAS patients were older and had more comorbidities. For RAAS patients, median time from radiation to diagnosis was 6 years (IQR: 5–11). RAAS patients were more likely to have a pCR to NAC (40% vs. 20%, p = 0.72). RAAS patients had a higher LR rate (43% vs. 38%, p = 0.83), and PAS patients were more likely to develop a DR (38% vs. 0%, p = 0.07). Median OS was 81 months in PAS patients and 90 months in RAAS patients (p = 1.00). Discussion: Long-term survival can be achieved in patients with PAS and RAAS who undergo multimodality treatment. NAC can result in pCR. The long-term clinical implications of pCR warrant further investigation

An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and affects patients of all genders, races, ethnicities, and socioeconomic status. While the causes of HCC are numerous, the primary etiology is cirrhosis from alcohol and nonalcoholic fatty liver disease in the United States and from infectious agents such as Hepatitis B and Hepatitis C in the developing world. In patients at-risk for developing HCC, screening is recommended with ultrasound imaging and alpha fetoprotein laboratory tests. In socioeconomically vulnerable patients, however, individual-level barriers (eg, insurance status) and contextual-level disparities (eg, health facilities) may not be readily available, thus limiting screening. Additional challenges faced by racial/ethnic minorities can further challenge the spectrum of HCC care and lead to inadequate screening, delayed diagnosis, and unequal access to treatment. Efforts to improve these multilevel factors that lead to screening and treatment disparities are critical to overcoming challenges. Providing health insurance to those without access, improving societal challenges that confine patients to a lower socioeconomic status, and reducing challenges to seeking healthcare can decrease the morbidity and mortality of these patients. Additionally, engaging with communities and allowing them to collaborate in their own healthcare can also help to attenuate these inequities. Through collaborative multidisciplinary change, we can make progress in tackling disparities in vulnerable populations to achieve health equit

Novel Coronavirus (COVID-19): telemedicine and remote care delivery in a time of medical crisis, implementation, and challenges

Abstract The novel Coronavirus (COVID-19) caused by the SARS-CoV-2 virus has led to many challenges throughout the world, one of which is the delivery of health care to patients while they remain home. Telemedicine, or the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, has been utilized by health care providers for many years, but its widespread implementation did not occur until the onset of the COVID-19 pandemic. Currently, it has become the primary mechanism of care delivery for patients during the COVID-19 pandemic. While obstacles are present for hospitals and providers to establish these services, most barriers exist with patient access. Patients require advanced technical support, translator services, and other measures to become comfortable engaging in a telemedicine encounter. In addition, appropriate follow-up must be provided for chronic medical illnesses and malignancies, helping to prevent the evolution of these conditions during the COVID-19 crisis. Finally, we must ensure equity for all patients seeking to access health services, including those of lower socioeconomic status. Many of these patients rely on public hotspots or library computers for their internet connectivity, but this is likely not conducive to a clinical encounter. These barriers must be addressed to ensure health equity for all patients seeking care. Telemedicine can connect patients and providers during this time of crisis and hopefully will serve as a model for continued use after the pandemic has abated

Chronic Stress, Biobehavioral Processes and Health Implications in Understanding Disparities

Stress is an important factor in disease risk and health outcomes; stress responses are now included in conceptual models of minority health and health disparities. This chapter reviews models of stress and adversity, identifies chronic stressors and stress responses in diverse communities, and examines the impact of chronic stressors in these groups. The effects of psychological interventions on stress responses, biobehavioral mechanisms, and cancer outcomes are also reviewed to identify priorities for future basic behavioral science research and intervention studies to enhance stress responses and cancer outcomes among disparity populations

Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors

This article examines the contextual and systemic factors that contribute to and exacerbate disparities in cancer care for Hispanic and Latino cancer patients

Medical Student Education During COVID-19: Electronic Education Does Not Decrease Examination Scores

During the COVID-19 emergency, medical students were mandated to remain home, creating challenges to providing education remotely for third-year clinical rotations. This study aims to assess student reception and investigate objective outcomes to determine if online learning is a suitable alternative. Medical students enrolled in the third-year surgical clerkship during COVID-19 were asked to participate in a survey. 19 of 27 (70%) students participated. Content, faculty-led lectures, and resident-led problem-based learning (PBL) sessions were assessed using a ten-point Likert scale. National Board of Medical Examiners (NBME) examination, weekly quiz, and oral examination scores were compared to previous years. Student -tests compared the groups. The median age was 25 years. Comparing in-person to electronic sessions, there was no difference in effectiveness of faculty sessions preparing students for NBME (6.2 vs. 6.7, = .46) or oral examinations (6.4 vs. 6.8, = .58); there was also no difference in resident-led PBL sessions preparing students for NBME (7.2 vs. 7.2, = .92) or oral examinations (7.4 vs. 7.6, = .74). Comparing this group to students from the previous academic year, there was no difference in weekly quiz (85.3 vs. 87.8, = .13), oral examination (89.8 vs. 93.9, = .07), or NBME examination (75.3 vs. 77.4, = .33) scores. Surgical medical didactic education can effectively be conducted remotely through faculty-led lectures and resident-led PBL sessions. Students did not have a preference between in-person and electronic content in preparation for examinations. As scores did not change, electronic education may be adequate for preparing students for examinations in times of crisis such as COVID-19

Health Care for the Homeless Transgender Community: Psychiatric Services and Transition Care at a Student-Run Clinic

Transgender individuals disproportionately experience homelessness and health disparities, including lack of access to gender-affirming care. The student-run Lotus Wellness Center provides care to transgender individuals experiencing homelessness, including primary care, mental health stabilization, and transition via hormone therapy, while medical students learn of the unique health needs of this community