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BACKGROUND Targeted therapy represents an effective modality for metastatic colorectal cancer (mCRC) with substantial health benefits. Targeted agents for mCRC have been approved for over a decade. However, little is known about their application in real-world clinical practice. OBJECTIVE We aimed to explore the uptake of targeted therapy and determine barriers and factors associated with initiating targeted therapy among Chinese mCRC patients. METHODS A cross-sectional, multi-center, hospital-based survey was conducted in China, from March 2020 to March 2021. mCRC patients who had finished at least one cycle of chemotherapy were enrolled from nineteen hospitals in fourteen cities through stratified, multistage cluster sampling. Descriptive analyses were used to report patients' characteristics, distribution on the timing and kinds of targeted agents first time used, and barriers against targeted therapy. Logistic regressions were conducted to assess the factors associated with initiating targeted therapy. RESULTS A total of 1,688 mCRC patients were included. Slightly over half the patients (51.6%, 871/1,688) have initiated the targeted therapy, of whom, 44.5% (388/871), 20.2% (176/871), and 35.2% (307/871) first initiated as the first-line, second-line, and third-line therapy, respectively. Bevacizumab was most frequently used (68.4%, 596/871). Unaffordable medical costs (41.6%, 340/817), not convinced that targeted therapy works (30.8%, 252/817) and fear of side effects (17.3%, 141/817) were the most reported barriers against targeted therapy. Patients treated in the general hospital, and with lower level of education, less annual family income, no medical insurance, poor health-related quality of life prior to the first treatment of mCRC, metastasis outside liver/lung or systemic metastasis, a duration of mCRC CONCLUSIONS This study highlights the limited uptake of targeted therapy, and frequent delayed treatment and misuse of targeted agents among mCRC patients in China. Reducing the costs, and interventional education on improving public awareness were recommended to facilitate the application of targeted therapy.

BACKGROUND: Colorectal cancer (CRC) causes a substantial disease burden in China. Information on the medical expenditure of CRC patients is critical for decision-makers to allocate medical resources reasonably, however, relevant data is limited in China, especially advanced CRC. The aim of this survey was to quantify the out-of-pocket medical expenditure of advanced CRC and explore associated factors. METHODS: A nation-wide, multi-center, cross-sectional survey was conducted from March 2020 to March 2021. Nineteen hospitals in seven geographical regions were selected by multi-stage stratified sampling. For each eligible CRC patient with stage III or IV disease in the selected hospitals, the socio-demographics, clinical information, and range of out-of-pocket medical expenditure data were collected based on patients’ self-reporting or medical records. Multivariable logistic analysis was used to explore associated factors of medical expenditure. All statistical analyses were conducted using SAS 9.4. RESULTS: The mean age of the 4,428 advanced CRC patients included was 59.5±11.6 years, 59.6% were male, and 80.1% of patients were in stage III or IV at the time of diagnosis. Besides, 57.2% of patients had an annual household income of less than 50,000 Chinese Yuan (CNY), 40.9% of patients had an out-of-pocket medical expenditure of 50,000–99,999 CNY. As for the affordability of medical expenditure, 33.2% could afford 50,000–99,999 CNY. Multivariate analysis showed that patients who were in the southern [odds ratio (OR): 1.63, 95% confidence interval (CI): 1.31–2.03] and southwestern (OR: 1.55, 95% CI: 1.25–1.93), were in stage III at the time of diagnosis (OR: 1.33, 95% CI: 1.13–1.57), visited three or more hospitals (OR: 1.26, 95% CI: 1.04–1.52), had sought cross-regional health care (OR: 1.60, 95% CI: 1.40–1.83), used genetic testing (OR: 1.26, 95% CI: 1.10–1.45) and targeted drugs (OR: 2.12, 95% CI: 1.79–2.51) had higher out-of-pocket medical expenditure. CONCLUSIONS: Patients with advanced CRC had a high out-of-pocket medical expenditure. It is necessary to strengthen the prevention and control of CRC to reduce the disease burden; also, it is critical to deepen the reform of the medical system, increase proportion of medical insurance reimbursement, and remove barriers to cross-regional health care.

BACKGROUND: Biomarkers are a key tool in early detection, prognostication, survival, and predicting treatment response of colorectal cancer (CRC). However, little is known about biomarker testing for CRC patients in real-life clinical practice in China. This study aimed to address the usage of biomarker testing and analyze factors related to its acceptance among Chinese patients with advanced CRC. METHODS: A multicenter, cross-sectional, hospital-based clinical epidemiology study was conducted from March 2020 to March 2021. Nineteen hospitals were selected in seven geographical regions of China using stratified, multistage, nonrandomized cluster sampling. Data on demographics and clinical characteristics of each eligible CRC patient in stage III or IV diseases were recorded based on the patients’ self-reporting and/or medical records. In addition, information on whether biomarker testing [RAS, BRAF, and microsatellite instability (MSI)] was performed, the results and timing for performing biomarker testing, and the reasons for refusing biomarker testing were also recorded. Univariate and multivariate logistic regression were conducted to explore the potential factors of biomarker testing. RESULTS: A total of 4,526 patients were enrolled in the study, of whom 41.4%, 36.1%, and 28.2% underwent RAS, BRAF, and MSI testing, respectively. RAS, BRAF, and high-level MSI (MSI-high) mutation rates in Chinese patients with advanced CRC were 37.0%, 9.9%, and 8.1%, respectively. The logistic regression analysis revealed that the treating hospital, age at diagnosis, education, family income, tumor site, history of chemotherapy and radiotherapy, and metastases were dependent factors affecting the utilization of biomarker testing in advanced CRC in China (P

BACKGROUND: The imbalanced allocation of medical resources leads to the occurrence of cross-regional healthcare-seeking in China. Due to the low cure rate, advanced colorectal cancer (CRC) patients may seek cross-regional healthcare for high-level medical facilities. Investigating status of cross-regional healthcare-seeking and its associated factors among advanced CRC patients is important for policymakers to understand access to health services and improve the quality of oncology services. METHODS: From March 2020 to March 2021, a cross‑sectional, nation-wide, hospital-based, multi-center survey was conducted. Nineteen hospitals in seven regions were selected by multi-stage stratified sampling. All eligible CRC patients in the selected hospitals were invited to participate in the current study. The outcome variable, cross-regional healthcare-seeking, was defined as seeking health facilities outside the local administration policy of medical insurance. The demographics, clinical information, and medical treatment history of each eligible CRC patient in stage III or IV, were collected through the patients’ self-reporting or medical records by trained interviewers. Univariate and multivariate logistic analyses were used to explore the associated factors of cross-regional healthcare-seeking. All statistical analyses were conducted using SAS 9.4. RESULTS: A total of 4,589 individuals with advanced CRC were included. The average age of the patients was 60.1±11.6 years, and 59.5% were males. About 37.5% of the patients suffered from metastatic CRC at first diagnosis. Approximately 36.5% of the patients had sought cross-regional health care previously, and among them, 31.9% had encountered problems. The most common problems included complicated procedures (95.3%), unreimbursed expenses of outpatient service (71.0%), and reimbursement delay (59.4%). Logistic regression analysis showed that patients who completed undergraduate or above [odds ratio (OR) =1.40, 95% confidence interval (CI): 1.13–1.73], had an annual household income of more than 100,000 Chinse Yuan (CNY) (OR =1.46, 95% CI: 1.21–1.78), and had metastasis at diagnosis (OR =1.33, 95% CI: 1.18–1.51) were more likely to seek cross-regional health care. CONCLUSIONS: About one third of advanced CRC patients seek cross-regional health care, and 31.9% had encountered problems. There is a need to simplify procedures of reimbursement, optimize direct settlement system and referral mechanisms in order to improve the equality of health services.

Objective. The aim of this study is to systematically evaluate the clinical efficacy and safety of the traditional Chinese medicine prescription Jade Screen combined with desloratadine in the treatment of chronic urticaria. Methods. Two researchers independently conducted literature searches. The extracted data were analyzed using Rev Man 5.2.3 software. The established retrieval time range of the various databases was up to 15 March, 2017. Results. Sixteen randomized controlled trials were included in this study. The results of the meta-analysis showed that the total effective rate of using Jade Screen and desloratadine in combination to treat chronic urticaria was higher than that with desloratadine alone (P<0.00001), while its recurrence rate (P<0.00001) and symptom score (P=0.006) were both significantly lower than the latter. The rate of adverse reaction in the combination group was lower than that when orally taking desloratadine alone (P=0.74), and the serum level of total IgE in the combination group was lower than that when orally taking desloratadine alone (P=0.82); however, the results of the rate of adverse reaction and the serum level of total IgE were insignificant. Conclusion. Using Jade Screen and desloratadine together to treat chronic urticaria gains a better clinical effect than using desloratadine alone.

To determine the effects of Chinese herbal monomers such as baicalin, berberine, and matrine on the androgen receptor (AR) mRNA expression in SZ95 sebocytes in vitro and to explore the possible mechanism of using traditional Chinese medicines to treat acne.SZ95 sebocytes were cultured and then treated with berberine, baicalin, matrine, and 13-cis-retinoic acid for 24 hours. Reverse transcription polymerase chain reaction was applied to detect the changes of AR.AR mRNA was downregulated by 13-cis-retinoic acid of 1 x 10(-5) mol/L and 1 x 10(-6) mol/L, and by baicalin of 1 x 10(-4) mol/L (P0.05).13-cis-retinoic acid and baicalin may exert antiandrogenitic action by inhibiting AR mRNA expression in human sebocytes.