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

Abstract

Background Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety‐net hospitals is unknown. Methods Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. Results Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver‐directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001). Conclusion Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.

Implementation of a Hepatocellular Carcinoma Screening Program for At-risk Patients Safety-Net Hospital: A Model for National Dissemination

“…These data represent a marked improvement when contrasted with the baseline data that prompted the development of this screening program. The original analysis reported that only 23% of patients diagnosed with HCC from 2012 to 2016 had received any imaging exam within the year before diagnosis, 44% of patients presented with stage IV disease, and over 60% of patients diagnosed with HCC in this time period did not receive treatment 11. It is important to note when making this comparison that these were patients from throughout Grady Health System and not necessarily Liver Clinic patients.…”

“…The original analysis reported that only 23% of patients diagnosed with HCC from 2012 to 2016 had received any imaging exam within the year before diagnosis, 44% of patients presented with stage IV disease, and over 60% of patients diagnosed with HCC in this time period did not receive treatment. 11 It is important to note when making this comparison that these were patients from throughout Grady Health System and not necessarily Liver Clinic patients. Of 22 patients diagnosed with HCC during the first 3 years of this new initiative, only 16% presented with stage IV disease.…”

“…In order to explore historical screening rates at a local level, our group previously evaluated all patients diagnosed with HCC at Grady Memorial Hospital (GMH) from January 2009 through December 2016. GMH is a large Safety-Net institution in the southeast predominantly serving the population of Atlanta’s Fulton and Dekalb counties 11. Of 204 patients, the vast majority had cirrhosis secondary to HCV infection (74%) and only 23% had received a screening exam (CT or MRI) within 1 year of HCC diagnosis.…”

“…GMH is a large Safety-Net institution in the southeast predominantly serving the population of Atlanta's Fulton and Dekalb counties. 11 Of 204 patients, the vast majority had cirrhosis secondary to HCV infection (74%) and only 23% had received a screening exam (CT or MRI) within 1 year of HCC diagnosis. Unsurprisingly, patients who had undergone screening were diagnosed at an earlier stage (58% stage 1 or 2 vs 23% stage 4) compared with patients who had not (22% stage 1 or 2 vs 48% stage 4, P = 0.001).…”

“…Unsurprisingly, patients who had undergone screening were diagnosed at an earlier stage (58% stage 1 or 2 vs 23% stage 4) compared with patients who had not (22% stage 1 or 2 vs 48% stage 4, P = 0.001). 11 The documentation of poor screening rates and advanced disease in the analyzed Safety-Net population identified an opportunity for improvement. A screening program was established and the experience with this program form the foundation of this study.…”