In this case study, a 73-year-old man who had previously undergone colectomy had a history of ulcerative colitis and alcohol abuse and presented with fatigue, weight loss, and a liver lesion. After a biopsy, he was diagnosed with stage IV-A hepatocellular carcinoma with poor differentiation and cirrhotic architecture, and molecular testing revealed positivity for multiple genes. A combination of atezolizumab and bevacizumab was administered, resulting in complete remission lasting beyond 16 months, demonstrating the potential of these drugs as a treatment option for advanced hepatocellular carcinoma (HCC). The patient's history of autoimmune conditions could have contributed to his robust response to the treatment. The report highlights the sustained survival benefits of this treatment beyond month 16.
Background The COVID-19 pandemic brought an unprecedented disruption to many hospital standard operating procedures including changing family visitation policies. As an infection control policy, most hospitals denied or limited visitors and patient families were updated via phone or video conferencing. There are several plausible reasons to suspect that altered communication techniques and heightened public awareness of critical illness during the pandemic impacted end of life care and decision making. Methods We conducted a retrospective observational cohort study from a tertiary care hospital to determine if more patients in the ICU were transitioned to comfort measures only (CMO) care during COVID than in the same period the year before when COVID had not yet arrived in the United States (“pre-pandemic”). Collected information included demographics (Table 1), reason for ICU, co-morbidities, code status at admission, length of ICU stay, cost of care during ICU admission, and disposition at discharge. All analyses began using the Kolmogorov -Smirnov test. Normally distributed continuous variables are compared between groups using the independent-samples t-test. Non-normally distributed continuous variables are compared between groups using the Mann-Whitney U test. Results There were no statistically significant differences in baseline demographic and clinical characteristics of patients admitted to the medical ICU during the pre-pandemic versus pandemic periods (Table 1). Among the 266 patients admitted during the pre-pandemic period, 11.7% (31/266) were discharged with CMO code status. Among the 160 patients admitted in the pandemic period, 8.8% (14/160) were discharged with CMO code status (Table 2). The median APACHE score was significantly higher in the pre-pandemic period ([median=18 (interquartile range = 11) compared to the pandemic period ([median=15 (interquartile range = 1), (Mann-Whitney U = 17146.50, p = .008). The cost of an ICU admission during the pandemic period increased 0.099%. Table 1Baseline demographic and clinical characteristics of patients admitted to the medical ICU pre- versus post-pandemic (n = 426).Table 2Discharge status code and outcomes of patients admitted to the medical ICU in the pre- versus post-pandemic (n = 426). Conclusion This study shows that despite the highmorbidity and mortality associated with COVID, during the study time periods, the limitation of in-person visitors did not have an impact on the frequency of patients transitioned to CMO or decreased hospital expenditure. Disclosures Tariq Cheema, MD, GSK,BI,ASTRA ZENECA,Regenoron: Honoraria.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.