Disparities in the Radiation Treatment Time and Outcome of Anal Cancer in Public and Private Hospital Patients

Author(s):  
S.K. Yoo ◽  
J. Guan ◽  
A.A. Ahmed ◽  
A. Barzi ◽  
S. Song
2014 ◽  
Vol 90 (1) ◽  
pp. S33-S34
Author(s):  
D.S. Bitterman ◽  
D. Grew ◽  
C.G. Leichman ◽  
L. Leichman ◽  
K.L. Du

2016 ◽  
Vol 96 (5) ◽  
pp. 967-975 ◽  
Author(s):  
Talha Shaikh ◽  
Elizabeth A. Handorf ◽  
Colin T. Murphy ◽  
Ranee Mehra ◽  
John A. Ridge ◽  
...  

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Martin P. Nilsson ◽  
Anders Johnsson ◽  
Jonas Scherman

Abstract Background Treatment-related white blood cell (WBC) toxicity has been associated with an inferior prognosis in different malignancies, including anal cancer. The aim of the present study was to investigate predictors of WBC grade ≥ 3 (G3+) toxicity during chemoradiotherapy (CRT) of anal cancer. Methods Consecutive patients with locally advanced (T2 ≥ 4 cm—T4 or N+) anal cancer scheduled for two cycles of concomitant 5-fluorouracil and mitomycin C chemotherapy were selected from an institutional database (n = 106). All received intensity modulated radiotherapy (IMRT; mean dose primary tumor 59.5 Gy; mean dose elective lymph nodes 45.1 Gy). Clinical data were extracted from medical records. The highest-grade WBC toxicity was recorded according to CTCAE version 5.0. Pelvic bone marrow (PBM) was retrospectively contoured and dose-volume histograms were generated. The planning CT was used to measure sarcopenia. Dosimetric, anthropometric, and clinical variables were tested for associations with WBC G3+ toxicity using the Mann–Whitney test and logistic regression. Cox proportional hazard regression was used to assess predictors for overall survival (OS) and anal cancer specific survival (ACSS). Results WBC G3+ was seen in 50.9% of the patients, and 38.7% were sarcopenic. None of the dosimetric parameters showed an association with WBC G3+ toxicity. The most significant predictor of WBC G3+ toxicity was sarcopenia (adjusted OR 4.0; P = 0.002). Sarcopenia was also associated with an inferior OS (adjusted HR 3.9; P = 0.01), but not ACSS (P = 0.07). Sensitivity analysis did not suggest that the inferior prognosis for sarcopenic patients was a consequence of reduced doses of chemotherapy or a prolonged radiation treatment time. Patients who experienced WBC G3+ toxicity had an inferior OS and ACSS, even after adjustment for sarcopenia. Conclusions Sarcopenia was associated with increased risks of both WBC G3+ toxicity and death following CRT for locally advanced anal cancer. In this study, radiation dose to PBM was not associated with WBC G3+ toxicity. However, PBM was not used as an organ at risk for radiotherapy planning purposes and doses to PBM were high, which may have obscured any dose–response relationships.


2020 ◽  
Vol 18 (2) ◽  
pp. 178-185
Author(s):  
Puspa Mani Kharal ◽  
Prakriti Bhattarai ◽  
Prithutam Bhattarai ◽  
Shyam Thapa

Background: In Nepal, the private sector has prominently emerged as a provider of health services in recent years. The objective of this paper is to assess whether public and private hospitals are competing for patients with similar socioeconomic strata, or providing services to different segments of the patient population. Methods: Data were collected prospectively from one public hospital and one private-for-profit hospital, both located in close proximity to one another in Tanahu district. A total of 384 and 389 patients presenting themselves for outpatient services available at the district public hospital and a private hospital, respectively, were systematically selected and interviewed using a survey form. The profiles of the patients were comparatively analyzed, and the reasons for using a particular hospital were assessed. Binary logistic regression was used for multivariate analysis.Results: Compared to the patients using the public hospital, patients at the private hospital were younger, possessed a higher level of education, represented indigenous and disadvantaged ethnic groups, and belonged to business or agricultural occupations. The four prominent reasons for using the private hospital were: positive perception/prior experience, followed by recommendation/word-of-mouth, timely availability of services, and trustworthiness. Among the public hospital patients, the prominent reasons were: low fee for services or having insurance, positive perception/prior experience, and trustworthiness. Conclusions: Public and private hospitals have played a complementary role in serving the health needs of different patient population segments in the study district. Keywords: Nepal; private hospital; public hospital; reasons for use; users profile.


2017 ◽  
Vol 98 (5) ◽  
pp. 1142-1152 ◽  
Author(s):  
Matthew T. McMillan ◽  
Eric Ojerholm ◽  
Vivek Verma ◽  
Kristin A. Higgins ◽  
Sunil Singhal ◽  
...  

2017 ◽  
Vol 138 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Andrew M. Vahabzadeh-Hagh ◽  
Jean-Claude M. Rwigema ◽  
Vishad Nabili ◽  
Marilene B. Wang ◽  
William C. Lorentz

2005 ◽  
Vol 76 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Sophie Pinel ◽  
Pascal Chastagner ◽  
Jean-Louis Merlin ◽  
Christian Marchal ◽  
Alphonse Taghian ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document