BACKGROUND & AIMS
Little is known about provider and health system factors that affect
receipt of active therapy and outcomes of patients with hepatocellular
carcinoma (HCC). We investigated patient, provider, and health system
factors associated with receipt of active HCC therapy and overall
survival.
METHODS
We performed a national, retrospective cohort study of all patients
diagnosed with HCC from January 1, 2008 through December 31, 2010 (n
= 3988) and followed through December 31 2014 who received care
through the Veterans Administration (128 centers). Outcomes were receipt of
active HCC therapy (liver transplantation, resection, local ablation,
transarterial therapy, or sorafenib) and overall survival.
RESULTS
In adjusted analyses, receiving care at an academically affiliated
Veterans Administration hospital (odds ratio [OR], 1.97;
95% confidence interval [CI], 1.60–2.41) or
a multi-specialist evaluation (OR, 1.60; 95% CI, 1.15–2.21),
but not review by a multidisciplinary tumor board (OR, 1.19; 95% CI,
0.98–1.46), was associated with a higher likelihood of receiving
active HCC therapy. In time-varying Cox proportional hazards models, liver
transplantation (hazard ratio [HR], 0.22; 95% CI,
0.16–0.31), liver resection (HR, 0.38; 95% CI,
0.28–0.52), ablative therapy (HR, 0.63; 95% CI,
0.52–0.76), and transarterial therapy (HR, 0.83; 95% CI,
0.74–0.92) were associated with reduced mortality. Subspecialist
care by hepatologists (HR, 0.70; 95% CI, 0.63–0.78), medical
oncologists (HR, 0.82; 95% CI, 0.74–0.91), or surgeons (HR,
0.79; 95% CI, 0.71–0.89) within 30 days of HCC diagnosis,
and review by a multidisciplinary tumor board (HR, 0.83; 95% CI,
0.77–0.90), were associated with reduced mortality.
CONCLUSIONS
In a retrospective cohort study of almost 4000 patients with HCC
cared for at VA centers, geographic, provider, and system differences in
receipt of active HCC therapy are associated with patient survival.
Multidisciplinary methods of care delivery for HCC should be prospectively
evaluated and standardized to improve access to HCC therapy and optimize
outcomes.
