Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma

Abstract

Patients at SNHs are less likely to undergo HCC treatment, even when diagnosed at an early stage, which likely contributes to worse survival. System-level differences in care delivery may partly explain racial/ethnic and socioeconomic disparities in HCC prognosis. Cancer 2018;124:743-51. © 2017 American Cancer Society.

Reply

“…High heterogeneity of intra-individual FC measurement has already been described. [4][5][6][7] We would like to alert clinicians to the measurement uncertainty of the FC assay within the same laboratory ( Figure 1A) and mostly among laboratories. Indeed, an external quality assessment by EQUALIS of 69 laboratories showed an inter-laboratory coefficient of variation about 42.6% for a target concentration of 174 mg/ g. Minimum was 49.5 mg/g, ie, at the limit of the pathologic threshold, and maximum was 287 mg/g, which is above the threshold used by Colombel et al This large variation is due, among others, to a high degree of stool heterogeneity, which was well-observed when we performed FC assays after extraction from a single location in the stool (Figure 1B and C).…”

Commentary: Do you live in a distressed community? How do you know? What does this mean? What are the risks? How do you get help?

“…Most, but not all, common medical and surgical disorders have worse outcomes in patients from distressed communities ( Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21] DOES LIVING IN A DISTRESSED COMMUNITY CAUSE WORSE OUTCOMES FROM SURGICAL PROCEDURES? Table 1 suggests that living in a distressed community is associated with worse outcomes from many medical disorders and from surgical interventions.…”

“…Hepatocellular cancer 21 TAVR, Transcatheter aortic valve replacement; CABG, coronary artery bypass grafting.…”

Optimizing cancer care for hepatocellular carcinoma at a safety‐net hospital: The value of a multidisciplinary disease management team

“…Management of HCC at a safety‐net hospital, where most patients are underinsured, uninsured, or utilize government insurance presents an additional challenge. Mokdad et al found that patients with HCC at a safety‐net hospital were less likely to undergo HCC directed treatment despite similar tumor stage at presentation. Additionally, of patients with localized disease, fewer received curative treatment at a safety‐net hospital than those at non–safety‐net hospitals …”

“…Additionally, of patients with localized disease, fewer received curative treatment at a safety-net hospital than those at non-safety-net hospitals. 10 It is believed that screening patients who have HBV and HCV for hepatocellular carcinoma can improve survival. In a study by Zhang et al, 11 in patients with known HBV or chronic hepatitis, screening with AFP testing and ultrasound every 6 months led to a 37% reduction in HCC-associated mortality.…”