Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Abstract

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.

Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma

“…Similar to the natural history of HCC, 41, 42 most of our HCC patients presented with advanced-stage disease. In addition, heathy control subjects were selected to represent the population from which case patients were ascertained.…”

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions

“…However, the success of these interventions may hinge on the creation of multidisciplinary teams for taking care of patients with advanced liver disease. Use of multidisciplinary teams may be important for all patients with cirrhosis, but currently these teams are most often used for hepatocellular cancer . Prior studies on the other aspects of cirrhosis complications, such as ascites, have demonstrated that fostering conditions that allow for guidelines to be followed can save costs and improve outcomes …”

Effects of Daily Alcohol Intake on Serum and Salivary Alpha-Amylase Activity Associated With Two Local Alcoholic Drinks of Benin

“…A declined acinar secretion may further increase the content of digestive enzymes in cells. This increase in enzyme content together with increased potential for contact between lysosomal enzymes (particularly cathepsin B, known to be capable of activating trypsinogen) and digestive enzymes may result in premature intracellular activation of digestive enzymes and, in the presence of (as yet unknown) a triggering agent, an overt attack of pancreatitis (Figarella et al, 1984;Saluja et al, 1996). This study has some limitations.…”