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Article ; Online: Racial and Ethnic Disparities in Hepatocellular Carcinoma Treatment Receipt in the United States: A Systematic Review and Meta-Analysis.

Wagle, Nikita Sandeep / Park, Sulki / Washburn, David / Ohsfeldt, Robert / Kum, Hye-Chung / Singal, Amit G

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

2024 Volume 33, Issue 4, Page(s) 463–470

Abstract: Background: Racial and ethnic disparities in hepatocellular carcinoma (HCC) prognosis exist, partly related to differential failures along the cancer care continuum. We characterized racial and ethnic disparities in treatment receipt among patients with ...

Abstract	Background: Racial and ethnic disparities in hepatocellular carcinoma (HCC) prognosis exist, partly related to differential failures along the cancer care continuum. We characterized racial and ethnic disparities in treatment receipt among patients with HCC in the United States. Methods: We searched Medline, Embase, and CINAHL databases to identify studies published between January 2012 and March 2022 reporting HCC treatment receipt among adult patients with HCC, stratified by race or ethnicity. We calculated pooled odds ratios for HCC treatment using random effects models. Results: We identified 15 studies with 320,686 patients (65.8% White, 13.9% Black, 10.4% Asian, and 8.5% Hispanic). Overall, 33.2% of HCC patients underwent any treatment, and 22.7% underwent curative treatment. Compared with White patients, Black patients had lower odds of any treatment (OR 0.67, 95% CI 0.55-0.81) and curative treatment (OR 0.74, 95% CI 0.71-0.78). Similarly, Hispanic patients had lower pooled odds of curative treatment (OR 0.79, 95% CI 0.73-0.84). Conclusions: There were significant racial and ethnic disparities in HCC treatment receipt, with Black patients having lower odds of receiving any and curative treatment while Hispanic patients having lower odds of curative treatment. Impact: Racial and ethnic differences in treatment receipt serve as an intervention target to reduce disparities in HCC prognosis.
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/therapy ; Carcinoma, Hepatocellular/pathology ; Ethnicity ; Healthcare Disparities ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy ; United States/epidemiology ; Racial Groups
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	1153420-5
ISSN	1538-7755 ; 1055-9965
ISSN (online)	1538-7755
ISSN	1055-9965
DOI	10.1158/1055-9965.EPI-23-1236
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Real-World Adherence and Effectiveness of Remote Patient Monitoring Among Medicaid Patients With Diabetes: Retrospective Cohort Study.

Park, Sulki / Kum, Hye-Chung / Zheng, Qi / Lawley, Mark A

Journal of medical Internet research

2023 Volume 25, Page(s) e45033

Abstract: Background: The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but ... ...

Abstract	Background: The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but there are barriers to their use. Remote patient monitoring (RPM) with appropriate support has the potential to provide solutions. Objective: We aim to investigate the adherence of Medicaid patients with diabetes to daily RPM protocols, the relationship between adherence and changes in blood glucose levels, and the impact of daily testing time on blood glucose changes. Methods: This retrospective cohort study analyzed real-world data from an RPM company that provides services to Texas Medicaid patients with diabetes. Overall, 180 days of blood glucose data from an RPM company were collected to assess transmission rates and blood glucose changes, after the first 30 days of data were excluded due to startup effects. Patients were separated into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 120 of the 150 days. z tests and t tests were performed to compare transmission rates and blood glucose changes between 2 cohorts. In addition, we analyzed blood glucose changes based on their testing time-between 1 AM and 10 AM, 10 AM and 6 PM, and 6 PM and 1 AM. Results: Mean patient age was 70.5 (SD 11.8) years, with 66.8% (n=255) of them being female, 91.9% (n=351) urban, and 89% (n=340) from south Texas (n=382). The adherent cohort (n=186, 48.7%) had a mean transmission rate of 82.8% before the adherence call and 91.1% after. The nonadherent cohort (n=196, 51.3%) had a mean transmission rate of 45.9% before and 60.2% after. The mean blood glucose levels of the adherent cohort decreased by an average of 9 mg/dL (P=.002) over 5 months. We also found that variability of blood glucose level of the adherent cohort improved 3 mg/dL (P=.03) over the 5-month period. Both cohorts had the majority of their transmissions between 1 AM and 10 AM, with 70.5% and 53.2% for the adherent and nonadherent cohorts, respectively. The adherent cohort had decreasing mean blood glucose levels over 5 months, with the largest decrease during the 6 PM to 1 AM time period (30.9 mg/dL). Variability of blood glucose improved only for those tested from 10 AM to 6 PM, with improvements of 6.9 mg/dL (P=.02). Those in the nonadherent cohort did not report significant changes. Conclusions: RPM can help manage diabetes in Medicaid clients by improving adherence rates and glycemic control. Adherence calls helped improve adherence rates, but some patients still faced challenges in transmitting blood glucose levels. Nonetheless, RPM has the potential to reduce the risk of adverse outcomes associated with diabetes.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Blood Glucose ; Blood Glucose Self-Monitoring ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy ; Medicaid ; Monitoring, Physiologic ; Retrospective Studies ; United States ; Telemedicine
Chemical Substances	Blood Glucose
Language	English
Publishing date	2023-08-22
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/45033
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A hemangioma in the masseter muscle: a case report.

Park, Daehwan / Park, Sulki / Baik, Bongsoo / Kim, Sunyoung

Archives of craniofacial surgery

2021 Volume 22, Issue 4, Page(s) 218–221

Abstract: Intramuscular hemangiomas of the masseter muscle are uncommon tumors and therefore can be difficult to accurately diagnose preoperatively, due to the unfamiliar presentation and deep location in the lateral face. A case of intramuscular hemangioma of the ...

Abstract	Intramuscular hemangiomas of the masseter muscle are uncommon tumors and therefore can be difficult to accurately diagnose preoperatively, due to the unfamiliar presentation and deep location in the lateral face. A case of intramuscular hemangioma of the masseter muscle in a 66-yearold woman is presented. Doppler ultrasonography showed a 34× 15 mm hypoechoic and hypervascular soft tissue mass in the left masseter muscle, suggesting hemangioma. The mass was excised via a lateral cervical incision near the posterior border of the mandibular ramus. The surgical wound healed well without complications.
Language	English
Publishing date	2021-08-20
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2800630-6
ISSN	2287-5603 ; 2287-1152
ISSN (online)	2287-5603
ISSN	2287-1152
DOI	10.7181/acfs.2021.00283
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Article: Corrigendum to "A hemangioma in the masseter muscle: a case report".

Park, Daehwan / Park, Sulki / Baik, Bongsoo / Kim, Sunyoung

Archives of craniofacial surgery

2021 Volume 22, Issue 5, Page(s) 285

Language	English
Publishing date	2021-10-20
Publishing country	Korea (South)
Document type	Journal Article ; Published Erratum
ZDB-ID	2800630-6
ISSN	2287-5603 ; 2287-1152
ISSN (online)	2287-5603
ISSN	2287-1152
DOI	10.7181/acfs.2021.00283.e1
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Article: Giant basal cell carcinoma of the left lateral neck.

Baik, Bongsoo / Park, Sulki / Ji, Soyoung / Kim, Sunyoung

Archives of craniofacial surgery

2021 Volume 22, Issue 3, Page(s) 173–176

Abstract: Basal cell carcinoma is a malignant epithelial neoplasm of the skin and the most common human skin cancer. It is generally associated with a good prognosis. In this case report, a giant basal cell carcinoma of the nodulo-ulcerative type showing wide ... ...

Abstract	Basal cell carcinoma is a malignant epithelial neoplasm of the skin and the most common human skin cancer. It is generally associated with a good prognosis. In this case report, a giant basal cell carcinoma of the nodulo-ulcerative type showing wide ulceration with marginal multiple small nodules, is presented. It was trapezoidal in shape, having dimensions of 7 cm at the greatest basal width, 6 cm vertically with different anterior and posterior margin dimensions, and 5 cm horizontally at the top margin. After wide excision of the lesion including 5-10 mm safety margins, the wound was reconstructed with a local skin flap and split-thickness skin graft. The reconstructed wound healed well without recurrence for 1 year.
Language	English
Publishing date	2021-06-25
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2800630-6
ISSN	2287-5603 ; 2287-1152
ISSN (online)	2287-5603
ISSN	2287-1152
DOI	10.7181/acfs.2021.00178
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Article ; Online: Correction: Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study.

Park, Sulki / Kum, Hye-Chung / Morrisey, Michael A / Zheng, Qi / Lawley, Mark A

Journal of medical Internet research

2022 Volume 24, Issue 6, Page(s) e39666

Abstract: This corrects the article DOI: 10.2196/29018.]. ...

Abstract	[This corrects the article DOI: 10.2196/29018.].
Language	English
Publishing date	2022-06-17
Publishing country	Canada
Document type	Published Erratum
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/39666
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Article ; Online: Prediagnostic CT or MRI Utilization and Outcomes in Hepatocellular Carcinoma: SEER-Medicare Database Analysis.

Karim, Mohammad A / Singal, Amit G / Kum, Hye Chung / Lee, Yi-Te / Park, Sulki / Rich, Nicole E / Noureddin, Mazen / Yang, Ju Dong

Cancer research communications

2023 Volume 3, Issue 5, Page(s) 874–883

Abstract: Ultrasound-based surveillance has suboptimal sensitivity for early hepatocellular carcinoma (HCC) detection, generating interest in alternative surveillance modalities. We aim to investigate the association between prediagnostic CT or MRI and overall ... ...

Abstract	Ultrasound-based surveillance has suboptimal sensitivity for early hepatocellular carcinoma (HCC) detection, generating interest in alternative surveillance modalities. We aim to investigate the association between prediagnostic CT or MRI and overall survival in a contemporary cohort of patients with HCC. Using the Surveillance Epidemiology and End Results (SEER)-Medicare database, we analyzed Medicare beneficiaries diagnosed with HCC between 2011 and 2015. Proportion of time covered (PTC) was defined as the proportion of the 36-month period prior to HCC diagnosis in which patients had received abdominal imaging (ultrasound, CT, MRI). Cox proportional hazards regression was used to investigate the association between PTC and overall survival. Among 5,098 patients with HCC, 3,293 (65%) patients had abdominal imaging prior to HCC diagnosis, of whom 67% had CT/MRI. Median PTC by any abdominal imaging was 5.6% [interquartile range (IQR): 0%-36%], with few patients having PTC >50%. Compared with no abdominal images, ultrasound [adjusted HR (aHR): 0.87, 95% confidence interval (CI): 0.79-0.95] and CT/MRI group (aHR: 0.68, 95% CI: 0.63-0.74) were associated with improved survival. Lead-time adjusted analysis showed improved survival continued to be observed with CT/MRI (aHR: 0.80, 95% CI: 0.74-0.87) but not ultrasound (aHR: 1.00, 95% CI: 0.91-1.10). Increased PTC was associated with improved survival, with a larger effect size observed with CT/MRI (aHR per 10%: 0.93, 95% CI: 0.91-0.95) than ultrasound (aHR per 10%: 0.96, 95% CI: 0.95-0.98). In conclusion, PTC by abdominal images was associated with improved survival in patients with HCC, with potential greater benefit using CT/MRI. Regular utilization of CT/MRI before cancer diagnosis may have potential survival benefit compared to ultrasound in patients with HCC. Significance: Our population-based study using SEER-Medicare database demonstrated that proportion of time covered by abdominal imaging was associated with improved survival in patients with HCC, with potential greater benefit using CT/MRI. The results suggest that CT/MRI surveillance may have potential survival benefit compared with ultrasound surveillance in high-risk patients for HCC. A larger prospective study should be conducted for external validation.
MeSH term(s)	Humans ; Aged ; United States/epidemiology ; Carcinoma, Hepatocellular/diagnosis ; Liver Neoplasms/diagnosis ; Prospective Studies ; Medicare ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2023-05-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2767-9764
ISSN (online)	2767-9764
DOI	10.1158/2767-9764.CRC-23-0075
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma.

Lee, Yi-Te / Karim, Mohammad A / Kum, Hye Chung / Park, Sulki / Rich, Nicole E / Noureddin, Mazen / Singal, Amit G / Yang, Ju Dong

Clinical and molecular hepatology

2023 Volume 29, Issue 2, Page(s) 453–464

Abstract: Background/aims: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and ... ...

Abstract	Background/aims: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States. Methods: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses. Results: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83-2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45-2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68-5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71-3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08-1.27) compared to recognized cirrhosis. Conclusion: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.
MeSH term(s)	Humans ; Male ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/diagnosis ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Liver Neoplasms/complications ; Liver Neoplasms/diagnosis ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/epidemiology ; Risk Factors ; Fibrosis
Language	English
Publishing date	2023-02-01
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2672560-5
ISSN	2287-285X ; 2287-2728
ISSN (online)	2287-285X
ISSN	2287-2728
DOI	10.3350/cmh.2022.0450
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Zs.A 6769: Show issues

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Article ; Online: Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study.

Park, Sulki / Kum, Hye-Chung / Morrisey, Michael A / Zheng, Qi / Lawley, Mark A

Journal of medical Internet research

2021 Volume 23, Issue 9, Page(s) e29018

Abstract: Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because ... ...

Abstract	Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence.
MeSH term(s)	Adult ; Aged ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Humans ; Hypertension/therapy ; Medicaid ; Medication Adherence ; Telemedicine ; United States
Language	English
Publishing date	2021-09-06
Publishing country	Canada
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/29018
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Article ; Online: Clinical Characteristics and Outcomes of Nonalcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma in the United States.

Karim, Mohammad A / Singal, Amit G / Kum, Hye Chung / Lee, Yi-Te / Park, Sulki / Rich, Nicole E / Noureddin, Mazen / Yang, Ju Dong

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2022 Volume 21, Issue 3, Page(s) 670–680.e18

Abstract: Background & aims: The extent to which nonalcoholic fatty liver disease (NAFLD) contributes to hepatocellular carcinoma (HCC) prevalence in contemporary practices and whether there are any etiologic differences in surveillance receipt, tumor stage, and ... ...

Abstract	Background & aims: The extent to which nonalcoholic fatty liver disease (NAFLD) contributes to hepatocellular carcinoma (HCC) prevalence in contemporary practices and whether there are any etiologic differences in surveillance receipt, tumor stage, and overall survival (OS) remain unclear. We aimed to estimate the burden of NAFLD-related HCC and magnitude of associations with surveillance receipt, clinical presentation, and outcomes in a contemporary HCC cohort. Methods: In a cohort of HCC patients from the Surveillance, Epidemiology and End Results-Medicare database between 2011 and 2015, we used multivariable logistic regression to identify factors associated with surveillance receipt, early-stage tumor detection, and curative treatment. Cox regression was used to identify factors associated with OS. Results: Among 5098 HCC patients, NAFLD was the leading etiology, accounting for 1813 cases (35.6%). Compared with those with hepatitis C-related HCC, NAFLD was associated with lower HCC surveillance receipt (adjusted odds ratio, 0.22; 95% confidence interval [CI], 0.17-0.28), lower early-stage HCC detection (adjusted odds ratio, 0.49; 95% CI, 0.40-0.60), and modestly worse OS (adjusted hazard ratio, 1.20; 95% CI, 1.09-1.32). NAFLD subgroup analysis showed that early-stage HCC, absence of ascites/hepatic encephalopathy, surveillance, and curative treatment receipt were associated with improved OS. NAFLD patients with coexisting liver disease were more likely to have surveillance, early-stage detection, curative treatment, and improved OS than NAFLD patients without coexisting liver diseases. Conclusions: NAFLD is the leading etiology of HCC among Medicare beneficiaries. Compared with other etiologies, NAFLD was associated with lower HCC surveillance receipt, early-stage detection, and modestly poorer survival. Multifaceted interventions for improving surveillance uptake are needed to improve prognosis of patients with NAFLD-related HCC.
MeSH term(s)	Humans ; Aged ; United States ; Carcinoma, Hepatocellular/pathology ; Non-alcoholic Fatty Liver Disease/complications ; Liver Neoplasms/diagnosis ; Medicare
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2022.03.010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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