Urvish Jain

Individuals with ocular cancer (OC) face unique challenges at the end of life (EOL), often not only grappling with vision loss and loss of self-identity, but also delayed diagnosis, poor prognosis,...

Italy's neurosurgical system provides valuable insights for developed nations seeking to optimize care delivery while managing aging populations and resource constraints. With approximately 1000 neurosurgeons (1.69 per 100 000 people) distributed across 141 neurosurgical divisions, Italy delivers equitable access through its National Health Service while demonstrating exceptional cost-effectiveness, with procedures averaging $11 907 compared with $24 754 in the United States. Italy has integrated cutting-edge technologies including virtual and augmented reality applications that reduce surgical errors by up to 36% in mixed-reality neuronavigation, alongside virtual reality–based rehabilitation programs improving cognitive function and pain management. The system's 77 active multidisciplinary teams optimize complex cases in neuro-oncology and pediatric neurosurgery, supported by systematic care improvements including the Homogeneous Waiting Group approach for clinical prioritization, digital preassessment tools, and tele-neuro-rehabilitation programs that reduce hospital readmissions. Structured follow-up care with standardized 3 to 4 month intervals demonstrates superior early recurrence detection compared with variable international practices. This report will delve in greater detail Italy's innovative approach to neurosurgical procedures, training, and educational methodologies that are producing better outcomes for patients and health care professionals.

Objective: We aimed to quantify progress towards all 23 Healthy People 2030 leading health indicators (LHIs) national set targets. Understanding progress on these LHIs can guide policy reform that aims to improve US population health. Methods: Cross-sectional analysis based on de-identified, population-level federal data representing the US population, stratified by race, age, gender, income, and education using cluster-based and stratified sampling methods. Results: Of 23 LHIs, 5 were categorized as little to no detectable change, 5 as worsening, 6 as improving, 5 as target met or exceeded, and 2 with no updated current value. Notable improvements included treatment of adolescent depression, reducing binge drinking, and hypertension control, while worsening areas included drug-overdose deaths, homicides, and food insecurity. Inequalities have persisted or widened for most indicators. Conclusion: The United States is lagging or worsening in 10 of 23 Healthy People 2030 LHIs. Understanding the implications of such findings is valuable for highlighting health care gaps, pinpointing areas for improvement, and underscoring the need for action.

PURPOSE: Southeast Asia (SEA), home to over 690 million people across 11 countries—Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste, and Vietnam—features diverse socioeconomic contexts and cancer care landscapes. We report and interpret incidence and mortality statistics for hematologic malignancies (HMs) in SEA. METHODS: We analyzed 2022 Global Cancer Observatory data from the International Agency for Research on Cancer to report age-standardized incidence rate (ASIR) and age-standardized mortality rates (ASMR) per 100,000 individuals age 20 years and older. We focused on non-Hodgkin lymphoma (NHL), leukemia, multiple myeloma (MM), and Hodgkin lymphoma (HL), standardized using Segi-Doll world population estimates. RESULTS: Across 11 Southeast Asian countries, age-standardized incidence and mortality rates (ASIRs and ASMRs) for HMs vary widely, highlighting significant regional disparities. Singapore consistently reports the highest ASIRs for NHL, leukemia, MM, and HL, yet its ASMRs are much lower, reflecting strong health care infrastructure. Thailand, Brunei, and Malaysia mirror these associations, which are particularly pronounced in NHL and HL. In contrast, for leukemia and MM, Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Timor-Leste, and Vietnam demonstrated lower ASIR and ASMR that approaches ASIR, suggesting barriers to diagnosis and survivorship. Time trends suggest increasing mortality from MM and NHL, particularly in Thailand and the Philippines. Overall, survival outcomes correlate strongly with national health care capacity. CONCLUSION: Higher reported incidence in wealthier SEA countries may reflect greater diagnostic capacity, whereas similar incidence and mortality in low-income countries likely indicates limited access to timely diagnosis and treatment. Mortality patterns underscore the region's broad disparities in cancer care infrastructure and outcomes, shaped by socioeconomic and systemic health inequities.

Introduction: Hematological malignancies (HMs) represent a diverse spectrum of hematopoietic and lymphoid neoplasms involving the blood, bone marrow, and lymphatic organs. Better understanding of the burden of HMs in East Asia will allow for more targeted policy and public health efforts. Methods: Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we extracted 2021 and 1990–2021 trend estimates for total counts and age-standardized rates (per 100,000 person-years) for incidence, mortality, and disability-adjusted life years (DALYs) for leukemia and subtypes, multiple myeloma (MM), non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) in East Asia (China, Japan, North Korea, Republic of Korea, Mongolia, and Taiwan). Results: In 2021, the burden of HMs globally and in East Asia was driven by China and Japan. China had the highest global HM burden with 238,051 new cases, 117,188 deaths, and 3.9 million DALYs. NHL and leukemia accounted for the majority of new cases, deaths, and DALYs in all countries. From 1990 to 2021, in most HMs and countries the age-standardized incidence rate (ASIR) increased, while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDALYR) decreased. The notable exception is the significant increase of MM ASIR, ASMR, and ASDALYR in Mongolia, Taiwan, and China, with increases in China by 200–300%. Conclusions: With the significant contribution to the global burden of HMs from China and Japan, diagnosis and treatment of HMs in these two countries should be a primary global health focus. The significant relative increase of MM ASIR, ASMR, and DALYs across many East Asia countries, especially in China, highlights MM as an important public health focus. Significant variations between the other East Asia countries also warrant further country- and disease-specific investigations.

Background: Higher rates of radiation therapy (RT) noncompletion may be associated with certain demographic groups in patients with prostate cancer (PC). We examined disparities in noncompletion and receipt of shorter RT regimens among disaggregated Asian American and Pacific Islander groups in the US.Methods: We performed a retrospective cohort analysis of all patients diagnosed with localized PC (2004–2017) in the National Cancer Database who identified as White, East Asian, Southeast Asian, Pacific Islander, or South Asian who were treated with definitive RT. The two primary outcomes were 1) treatment noncompletion and 2) receiving shorter RT regimens. Regression models were adjusted for relevant sociodemographic and clinical factors.Results: The analytic cohort was comprised of 143,379 patients [White, n = 140,656 (98.10%); East Asian, n = 1,150 (0.80%); Southeast Asian, n = 925 (0.65%); Pacific Islander, n = 195 (0.14%); South Asian, n = 453 (0.32%)]. On multivariable analysis, Southeast Asian patients were associated with increased rate of noncompletion compared to White patients (Southeast Asian vs. White; OR: 1.55 [95% CI: 1.29–1.86], p < 0.001). Geographic region of the treatment facility within the United States also was significant, as patients from the South Atlantic (OR: 1.32 [95% CI: 1.24–1.41], p < 0.001), East North Central (OR: 1.09 [95% CI: 1.03–1.17], p = 0.007), East South Central (OR: 1.54 [95% CI: 1.41–1.68], p < 0.001), and West South Central (OR: 1.14 [95% CI: 1.04–1.24], p = 0.005) regions all had higher rates of noncompletion in comparison to patients from New England. Distance from treatment facility, presence of comorbidities, and education attainment rates significantly impacted treatment noncompletion as well.Additionally, our study reports disparities in receipt of short course RT. Pacific Islander patients had substantially higher rates of SBRT (OR: 2.60 [95% CI: 1.10–6.16], p = 0.030) compared to White patients, while Hispanic patients had lower rates of SBRT (OR: 0.48 [95% CI: 0.40–0.57], p < 0.001). Furthermore, receiving treatment in urban (OR: 0.68 [95% CI: 0.61–0.76], p < 0.001) and metro (OR: 0.50 [95% CI: 0.39–0.65], p < 0.001) facilities was associated with reduced access to SBRT than facilities in rural areas. Patients who received treatment in the Middle Atlantic (OR: 3.28 [95% CI: 2.91–3.68], p < 0.001), South Atlantic (OR: 2.72 [95% CI: 2.40–3.09], p < 0.001), East North Central (OR: 1.53 [95% CI: 1.34–1.75], p < 0.001), East South Central (OR: 3.07 [95% CI: 2.61–3.63], p < 0.001), West North Central (OR: 2.35 [95% CI: 2.02–2.75], p < 0.001), and Mountain (OR: 2.45 [95% CI: 2.01–2.97], p < 0.001) regions of the United States had significantly higher rates of SBRT compared to patients from New England.Conclusions: This analysis found that Southeast Asian patients had higher rates of RT noncompletion in comparison to White patients. Additionally, disparities in SBRT access–a shorter course of RT as compared to traditional therapies–were found based on race/ethnicity and geographical factors. Our findings emphasize heterogeneous differences amongst diverse Asian American and Pacific Islander groups and support the need for further disaggregated cancer disparities research to inform targeted interventions.