Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Social determinants of health (SDH) significantly impact HCC outcomes, yet comprehensive insights into these effects are lacking. This scoping review aimed to examine the influence of SDH on HCC outcomes. Following PRISMA-ScR guidelines, we searched 10 databases, including PubMed and Scopus, using terms related to HCC and SDH. We included studies published between 1994 and 2024, focusing on human participants and various study designs. A total of 20 studies were selected, including cross-sectional, cohort, and case-control studies. The review identified disparities in HCC outcomes linked to socioeconomic status, health care access, and racial and ethnic differences. Patients in disadvantaged socioeconomic conditions and marginalized racial groups faced delays in treatment and worse outcomes. United States–based studies highlighted pronounced disparities compared to studies in Argentina, France, and Australia. Various SDH metrics provided inconsistent results, illustrating a need for standardized measures. SDH significantly shapes HCC outcomes, revealing gaps in current research. Future studies should integrate various SDH factors using consistent metrics to improve HCC care and reduce health disparities.

This case report presents the management of a 25-year-old woman with refractory hemophagocytic lymphohistiocytosis (HLH) secondary to adult-onset Still’s disease. Despite initial treatment with corticosteroids and biologic therapies, including anakinra and tocilizumab, her condition continued to deteriorate, necessitating intensive care unit admission. Following multidisciplinary consultation, ruxolitinib therapy, a Janus kinase (JAK) inhibitor targeting hyperinflammation, was initiated. Remarkably, the patient exhibited significant clinical improvement with resolution of fever, normalization of inflammatory markers, and organ function recovery. This case underscores the potential of ruxolitinib as a therapeutic option in refractory cases of HLH or macrophage activation syndrome, highlighting the importance of exploring novel therapies in refractory and challenging clinical scenarios.

Previous studies have convincingly demonstrated the negative impact of dementia on overall health outcomes. In the context of the COVID-19 pandemic, there is burgeoning evidence suggesting a possible association between dementia and adverse outcomes, however the relationship has not been conclusively established. We conducted a retrospective cohort study involving 816,960 hospitalized COVID-19 patients aged 65 or older from the 2020 national inpatient sample. The cohort was bifurcated into patients with dementia (n = 180,845) and those without (n = 636,115). Multivariate regression and propensity score matched analyses (PSM) assessed in-hospital mortality and complications. We observed that COVID-19 patients with dementia had a notably higher risk of in-hospital mortality (23.1% vs. 18.6%; aOR = 1.2 [95% CI 1.1–1.2]). This elevated risk persisted even after PSM. Interestingly, dementia patients had a reduced risk of several acute in-hospital complications, including liver failure and sudden cardiac arrest. Nevertheless, they had longer hospital stays and lower total hospital charges. Our findings conclusively demonstrate that dementia patients face a heightened risk of mortality when hospitalized with COVID-19 but are less likely to experience certain complications. This complexity underscores the urgent need for individualized care strategies for this vulnerable group.

Background: Malignant bowel obstruction (MBO) is a complication of advanced abdominal cancer. Management should be individualized, ranging from surgical or endoscopic interventions to symptom control and comfort measures in inoperable cases. This study examines predictors of survival and disparities in treatment among patients with inoperable MBO. Methods: A retrospective cohort study was conducted on 63 patients with MBO treated non-operatively between July 2019 and June 2023 at the University of New Mexico in the Southwestern United States. Of 421 patients screened, exclusions were based on incomplete records or failure to meet clinical and radiological criteria for MBO. Data included demographics, tumor types, treatments, inflammatory markers, and outcomes. Statistical analyses included t-tests, logistic regression, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Length of stay (LOS) and survival duration were analyzed using mean differences. Subgroup comparisons identified disparities across gender, ethnicity, and language preferences. Results: The cohort included 39 females (61.9%) and 24 males (38.1%) with a mean age of 63.2 years [standard deviation (SD) =13.8]. The most common causes of MBO were gastrointestinal (GI) tumors (46%) and gynecologic cancers (34%). The median survival was 25 days, with significant disparities observed. Non-English speakers had higher odds of survival [odds ratio (OR) =5.56, P=0.04], while sepsis at admission was associated with 100% mortality. Elevated C-reactive protein (CRP) (15.85 vs. 8.78 days, P=0.06), steroid use (11.36 vs. 9.92 days, P=0.15), nasogastric (NG) tube placement (10.95 vs. 9 days, P=0.11), and parenteral hydration (12.55 vs. 9.16 days, P=0.37) were associated with longer LOS, though these differences did not reach statistical significance. Higher body mass index (BMI) correlated positively with survival [25.57 (24.0) vs. 24.17 (24.72) kg/m², P=0.03]. Female patients were more likely to receive NG tubes (OR =3.05, P=0.050) and achieve nonsurgical resolution (OR =3.45, P=0.041) but were less likely to enroll in hospice (OR =0.17, P=0.003). Steroids (22.2%) and octreotide (11.1%) were underutilized despite their role in symptom management. Conclusions: Disparities in MBO management highlight gaps in equitable care, particularly gender and language preference. Non-English-speaking patients had a survival advantage, underscoring the importance of culturally tailored care. The underutilization of palliative treatments, such as steroids and octreotide, reveals inconsistencies in guideline adherence. The association of sepsis with 100% mortality reinforces the need for early infection management. Standardized, evidence-based protocols and culturally appropriate care could improve outcomes for this high-risk population.

Datopotamab deruxtecan (Dato-DXd) is a TROP2-directed antibody-drug conjugate (ADC) that has received accelerated approval in the US for adults with locally advanced or metastatic EGFR-mutated non-small cell lung cancer (NSCLC) after progression on EGFR-directed therapy and platinum chemotherapy. In pooled analyses from TROPION-Lung01 and TROPION-Lung05, Dato-DXd achieved an objective response rate of ~45% and a median duration of response of 6.5 months, which compares favorably with historical outcomes with docetaxel. Dato-DXd is being evaluated in combination with osimertinib in the first-line and post-osimertinib settings, following encouraging activity in the phase II ORCHARD platform trial evaluating therapeutic strategies for EGFR-TKI-resistant disease. Importantly, Dato-DXd demonstrates a favorable safety profile and has lower rates of grade ≥3 adverse events and less hematologic toxicity than docetaxel. Adverse events of special interest include mucositis, interstitial lung disease, and ocular surface events. While these toxicities are generally manageable, they require prophylaxis, monitoring, and early intervention. Current research aims to elucidate the mechanisms underlying these toxicities and to identify modifiable risk factors to further improve tolerability. The biological mechanisms contributing to the differential efficacy of Dato-DXd are also under investigation and may further inform its clinical role.Expert opinion: Determining how best to integrate Dato-DXd within existing treatment sequences has the potential to meaningfully address persistent unmet needs in EGFR-mutated NSCLC.