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Master of Public Health

Disparities in Outcomes and Access to Therapy Options in Hepatocellular Carcinoma

AUTHORS

Ponce SB , Gokun Y , Douglass F , Dawson L , Miller E , Thomas CR , Pitter K , Conteh L , Diaz DA , . Journal of the National Cancer Institute. 2023 10 13; ().

ABSTRACT

INTRODUCTION: Hepatocellular carcinoma (HCC) disproportionately impacts racial and ethnic minorities and patients with lower socioeconomic status. These social determinants of health (SDH) lead to disparities in access to care and outcomes. We aim to understand the relationship between SDH and survival and locoregional treatment options in HCC.

METHODS: Utilizing the National Cancer Database, we evaluated survival and access locoregional treatments including non-transplant surgery, liver transplant (LT), liver-directed radiation therapy (LDRT), in patients with HCC diagnosed between 2004 and 2017. Variables including clinical stage, age, sex, race, income, rurality, year of diagnosis, facility type (FT), Charlson-Deyo score (CD), and insurance were evaluated. Cox Proportional Hazards multivariable regression and dominance analyses were used for analyses.

RESULTS: 140,340 patients were included. Worse survival was seen with advanced stage, older age, Black race, rurality, public insurance, treatment at a non-academic center, and lower income. The top predictors for survival included stage, age, and income. Completion of non-transplant surgery was best predicted by stage, FT, and insurance type while LT was predicted by age, year of diagnosis, and CD score. LDRT utilization was most associated with year of diagnosis, FT, and CD score.

CONCLUSION: For patients with HCC, survival was primarily predicted by stage, age, and income. The primary sociodemographic factors associated with access to surgical treatments, in addition to FT, were insurance and income, highlighting the financial burdens of healthcare. Work is needed to address disparities in access to care including improved insurance access, addressing financial inequities and financial toxicities of treatments, and equalizing care opportunities in community centers.

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