Significant Efficacy of Apatinib in a Patient With Hepatocellular Carcinoma Lung Metastases After Liver Transplantation: A Case Report

Antiangiogenesis therapy plays an important role in the treatment of advanced hepatocellular carcinoma (HCC). However, treatment options for HCC recurrence after liver transplantation are currently limited. Apatinib is a small tyrosine kinase inhibitor molecule targeting vascular endothelial growth factor receptor-2. Here, we report for the first time one case of a patient with advanced HCC who received apatinib after occurring lung metastasis 7 months after liver transplantation. He took 500 mg of apatinib daily for one month, which was decreased to 250 mg daily because of side effects. The patient was confirmed to have a partial response, according to the Response Evaluation Criteria in Solid Tumors, for 10 months, and the progression-free survival time was greater than 21 months. Our data and experience have indicated that apatinib may be a good choice for HCC recurrence after liver transplantation.

The Implementation of ISO 9001:2015 to Improve the Supportive Care Services for the Cancer Survivors

Background and context: Cancer has been the leading cause of death in Taiwan since 1982. According the most updated cancer registry published by the Ministry of Health and Welfare, a total of 105,156 new cases (302/100,000 population) were diagnosed and 46,829 people (128/100,000 population) died of cancer which accounted for 28.6% of all deaths. Currently, around 500,000 people live with cancers in Taiwan. The Formosa Cancer Foundation (FCF) operates two Cancer Survivor Supportive Care Centers in Taipei and Kaohsiung cities which provide comprehensive, professional services to cancer survivors and their families. These centers regularly offer free medical, nutritional and psychological counseling, nutrition and transportation subsidies for low-income survivor households, critical emergency relief as well as hold a regular courses of body and mind rehabilitation to help cancer survivors successfully navigate their road to optimal recovery. As the number of cancer survivors needed supportive care services are rapidly increasing, the resources allocated for the services is not proportionately increased. Therefore, how to improve both the quantity and quality for the survivors' supportive care services becomes an essential issue. Aim: To ensure service standardization as well as to improve the quantity and quality of the supportive care services for the cancer survivors. Strategy/Tactics: FCF began the process necessary to certify its Survivor Supportive Care Service Quality Management System under ISO 9001 since 2015. Program/Policy process: To certify the FCF Survivor Supportive Care Service Quality Management System under ISO 9001:2015 by (1) Clearly defining the assessment and service goals (2) Systemized management and control of service delivery procedures (3) Regular collection and utilization of client-satisfaction data and comments (4) Systemized tracking and management of documents (5) Standard method for records storage and maintenance (6) Standardized procedures for managing and maintaining service facilities; and (7) Standardized procedures for evaluating and training staff. Outcomes: After implementation of the ISO 9001:2015 quality management system, FCF's overall service capacity has increased by 18-20%. Each service now covered by a standardized procedure, high levels of service quality and teamwork have been well maintained even under reduced staffing conditions. Survivors’ satisfaction with FCF services has risen significantly from an average of 4.0 prior to implementation of the quality management system to 4.7 afterward (full score: 5). The survivor´s family members also indicate strong satisfaction with FCF services. What was learned: Implementing the ISO 9001:2015 quality management system in the cancer survivor supportive care service has assisted FCF not only to increase the quality and quantity of its service deliveries but also to enhance the effectiveness of its professional team.