Medicaid and Uninsured Hepatocellular Carcinoma Patients Have More Advanced Tumor Stage and Are Less Likely to Receive Treatment

Wang, Jennifer; Ha, John; Lopez, Aristeo; Bhuket, Taft; Liu, Benny; Wong, Robert J.

doi:10.1097/mcg.0000000000000859

Cited by 69 publications

(81 citation statements)

References 32 publications

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“…While BCLC stage differed across insurance groups, this is likely due to BCLC including liver disease and performance status in the staging algorithm, while AJCC staging does not . It has been noted that HCC patients with Medicaid or no insurance are more likely to present with late‐stage cancer vs patients with private insurance . Lack of long‐term insurance has also been associated with higher prevalence of metastases in both the University Health Consortium [OR 1.9, 95% CI: 1.6‐2.2] and Nationwide Inpatient Small [OR 1.6, 95% CI: 1.4‐1.9] databases …”

Section: Discussionmentioning

confidence: 99%

“…Primary insurance can serve as a surrogate parameter for SES. Various studies have reported that patients with Medicaid, underinsurance, no insurance, or lower SES are less likely to receive surgical treatment or even treatment in general . After controlling for tumor stage, resection status, and transplant eligibility, Sarpel found that patients with government insurance (Medicaid or Medicare without supplement) were less likely to undergo transplantation for HCC .…”

Section: Discussionmentioning

confidence: 99%

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The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

et al. 2019

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Background To investigate the impact of insurance status on outcomes in patients with hepatocellular carcinoma (HCC). Methods Patients diagnosed with HCC in the cancer registry from 2005 to 2016 were retrospectively stratified by insurance group. Overall survival was assessed via Kaplan‐Meier curves and Cox proportional hazard models including potential confounders in multivariable analyses. Results Seven hundred and sixty‐nine patients met inclusion criteria (median age 63 years, 78.8% male, 65.9% Caucasian). 44.5% had private insurance (n = 342), 29.1% had Medicare (n = 224), and 26.4% had Medicaid (n = 203). At diagnosis, Medicaid patients had higher rates of Child‐Pugh B (32.0%) and C disease (23.6%) vs Medicare (28.6% and 9.8%) and private insurance (26.9% and 6.7%, P < 0.0001) and higher MELD scores (median 11.0) vs Medicare (9.0) and private insurance (9.0, P = 0.0266). Across insurance groups, patients had similar distribution of American Joint Committee on Cancer stage, tumor size, and multifocal tumor burden. Patients with private insurance had the highest survival (median OS 21.9 months) vs Medicare (17.7 months) and Medicaid (13.0 months, overall P = 0.0061). On univariate analysis, Medicaid patients demonstrated decreased survival vs private insurance (HR 1.40, 95% CI: 1.146‐1.715, P = 0.0011). After adjustment for liver disease factors, this survival difference lost statistical significance (Medicaid vs private insurance, HR 1.02, 95% CI: 0.819‐1.266, P = 0.8596). Conclusion Medicaid was associated with advanced liver disease at HCC diagnosis; however, insurance status is not an independent predictor of HCC survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

et al. 2019

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“…While access to health care and preventive medical screening is available for the entire population in Germany, this is not the case in the USA. In the USA, it has been shown that hepatocellular carcinoma, for instance, is diagnosed in less advanced stages when comparing people with health insurance to people without insurance [32]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of Age on the Prognosis of Vulvar Cancer

Hami

Lampe²,

Mallmann

et al. 2018

Oncol Res Treat

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Introduction: Younger women are particularly affected by the increase in the incidence of vulvar cancer. The purpose of this study was to investigate how clinical characteristics differ depending on the patient´s age and what role the age of initial diagnosis plays in the prognosis. Patients andMethods: Included patients were divided into groups aged below or above 50 years. The disease-free survival (DFS) was calculated and a multivariate discriminant analysis was conducted. Results: Of the 300 patients, 79 were ≤50 years and 221 were >50 years. The median age was 64 years (19-96 years). There were no differences between the groups regarding lymph node (LN) status and distant metastasis, but T1 tumours were more frequent in patients ≤50 years (77% vs. 62%, p = 0.02). The DFS only differed between the groups when there were no LN metastases. The nodal status was the predominant prognostic factor for the DFS regardless of age. In node-free patients, the 5-year DFS was 49% for the ≤50 years group and 89% for the >50 years group (p = 0.008), whereas there was no difference if a LN was involved. Conclusion: In node-free patients, the risk for recurrence is lower for patients older than 50 years.

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“…5 A noninvasive CT-based radiomics nomogram was well established by Huang et al with an excellent performance in preoperative prediction of lymph node metastasis in colorectal cancer. 6 In contrast to the HVPG score, considering solely non-textural features (e.g. liver/spleen volume, peri-hepatic ascites), 1 a radiomics model integrating texture analysis of CT images can potentially increase the accuracy of identifying CSPH in patients with HBV-related cirrhosis.…”

mentioning

confidence: 99%

Insufficient accuracy of computed tomography-based portal pressure assessment in hepatitis B virus-related cirrhosis: An analysis of data from CHESS-1601 trial

Liu

Li³

et al. 2018

Journal of Hepatology

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We read with great interest the paper ''Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma", in which Iranmanesh et al. proposed a computed tomography (CT)-based model to non-invasively predict hepatic venous pressure gradient (HVPG). 1 The noninvasive CT-based model combining the liver/spleen volume ratio with the peri-hepatic ascites demonstrated a high accuracy for predicting HVPG >10 mmHg (area under the receiver operating characteristic curve [AUROC]: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%, respectively. 1 However, the diagnostic performance of the CT-based model (HVPG score) remains to be further externally validated in portal hypertension, with certain etiologies.As one of the global public health issues, hepatitis B virus (HBV) infection affects 20 million people in China, which accounts for more than 70% of patients with cirrhosis nationwide. 2 HVPG is currently the only validated approach to measure portal pressure and to risk stratify patients with HBV-related cirrhosis. However, the measurement is invasive and requires extensive experience. Thus, it fails as a routine examination. 3,4 Non-invasive models that correlate with HVPG are necessary. Thus, we aim to evaluate the performance of the HVPG score established by Iranmanesh et al. 1 in patients with HBV-related cirrhosis. In a pre-planned exploratory analysis of a multicenter prospective trial (CHESS-1601, ClinicalTrials.gov identifier: NCT02842697), a cohort of 131 adult patients with HBV-related cirrhosis was recruited. The male:female ratio was 103:28, with a mean age of 45.5 ± 10.6 years, a mean BMI of 22.68 ± 3.08 kg/m 2 and a mean HVPG of 16.58 ± 5.84 mmHg. In overall analysis, the HVPG score did not correlate well with HVPG (R = 0.048, p = 0.584) ( Fig. 1A), which was also confirmed by Bland-Altman plot (Fig. 1B). For diagnosing clinically significant portal hypertension (CSPH, HVPG >10 mmHg), the CT-based model also showed

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Medicaid and Uninsured Hepatocellular Carcinoma Patients Have More Advanced Tumor Stage and Are Less Likely to Receive Treatment

Abstract: Among US adults with HCC, MA, or NI patients had more advanced tumor stage at diagnosis, lower rates treatment, and significantly lower overall survival. Ensuring equal insurance coverage may improve access to care and mitigate some disparities in HCC outcomes.

Cited by 69 publications

References 32 publications

The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

The Impact of Age on the Prognosis of Vulvar Cancer

Insufficient accuracy of computed tomography-based portal pressure assessment in hepatitis B virus-related cirrhosis: An analysis of data from CHESS-1601 trial

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