Background Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor that can affect multiple organs. Little is known about the pathophysiology, clinical course and management of this disease. The aim of this study is to determine survival rates and elucidate the role of various prognostic factors and therapeutic modalities as compared to surgery on patients with HEH. Methods A retrospective analysis on patients diagnosed with HEH between 2004 and 2016 was performed utilizing the SEER database. Kaplan–Meier curves were constructed to determine overall and cancer‐specific survival, and the log‐rank test was used to compare between groups. To explore prognostic factors and treatment outcomes, univariable and multivariable Cox proportional hazard models were developed. Results A total of 353 patients with HEH (median age: 50.4 years) were identified. The most common surgery performed was liver resection (90.8%). One‐year OS in the surgical group and non‐surgical group was 86.6% and 61.0%, respectively, while 5‐year OS was 75.2% and 37.4%, respectively. On multivariable analysis, surgery emerged as a favorable prognostic factor [HR (95%CI): 0.404 (0.215–0.758) p value = 0.005]. Age > 65 years [HR (95%CI): 2.548 (1.442–4.506) p value = 0.001] and tumor size > 10 cm [HR (95%CI): 2.401 (1.319–4.37) p value = 0.004] were shown to be poor survival prognostic factors. Conclusion HEH is a rare disease that is poorly understood. Surgical intervention is associated with improved survival rates. Multicenter prospective collaborations are needed to improve our limited knowledge about this neoplasm and determine the optimal treatment strategy.

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Background Studies have shown that dementia caregivers are inclined to sacrifice their well-being leaving them susceptible to an increased risk of anxiety, low quality of life, and depression. With the proportion of female caregivers being unusually high, most studies focused exclusively on the burden of care in female caregivers, resulting in a knowledge gap regarding male caregiver burden. This study aimed to assess the difference in the burden of care experienced by male and female caregivers of dementia patients and the association of burden of care with psychological wellbeing according to gender. Methods This was a cross-sectional survey of dementia patients’ caregivers from various locations in Lebanon, administered over the phone using structured questionnaires from February to April 2019. The population consisted of 50 females and 11 males' informal unpaid caregivers above the age of 18 in daily contact with the patient. The sample was conveniently selected and identified through two main non-profit organizations. The patient and the caregiver’s sociodemographic information were recorded. The psychological distress was measured using the General Health Survey Questionnaire (GHQ 12) whereas the burden of care was measured using the Zarit Burden Interview 22 (ZBI 22). Results A large proportion of caregivers reported a severe level of burden (41 %). Only item 17 of the ZBI questionnaire (Feeling of life loss control since relative’s illness) was substantially higher among females. Of the caregivers, 70.5% experienced moderate to severe distress, being significantly higher in females. The sex of caregivers was the only socio-demographic factor significantly associated with the burden of care. Female caregivers who experienced severe burden had significantly higher odds of distress compared to those with no or mild to moderate burden (adjusted OR=15.55). No association among male caregivers.Conclusion This study demonstrated that female caregivers experience a greater burden compared to males when assessed about anger. This could be explained by the different gender roles imposed by the Lebanese society on its members. Caregivers should be part of the holistic treatment of dementia patients since they represent an essential pillar of the informal care provided.

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