Socioeconomic Factors Affect Disparities in Access to Liver Transplant for Hepatocellular Cancer

Abstract

Objective. The incidence/death rate of hepatocellular cancer (HCC) is increasing in America, and it is unclear if access to care contributes to this increase. Design/Patients. 575 HCC cases were reviewed for demographics, education, and tumor size. Main Outcome Measures. Endpoints to determine access to HCC care included whether an eligible patient underwent liver transplantation. Results. Transplant patients versus those not transplanted were younger (55.7 versus 61.8 yrs, P < 0.001), males (89.3% versus 74.4%, P = 0.013), and having completed high school (10.1% versus 1.2%, P = 0.016). There were differences in transplant by ethnicity, insurance, and occupation. Transplant patients with HCC had higher median income via census classification ($54,383 versus $49,383, P = 0.046) and self-reported income ($48,948 versus $38,800, P = 0.002). Differences in access may be related to exclusion criteria for liver transplant, as Pacific Islanders were more likely to have tumor size larger than 5 cm compared to Whites and have BMI > 35 (20.7%) compared to Whites (6.4%) and Asians (4.7%). Conclusions. Ethnic differences in access to transplant are associated with socioeconomic status and factors that can disqualify patients (advanced disease/morbid obesity). Efforts to overcome educational barriers and screening for HCC could improve access to transplant.

How admissions to various medical specialty divisions determines the outcome of patients with hepatocellular carcinoma: results from a retrospective study in a large hospital of northwest China

“…The complexity of HCC, including the etiology, co-morbidity, or underlying associated liver disease, may affect the treatment choice. The patient’s economic condition is likely another important determinant of treatment,19,20 which may be particularly relevant to our study which was conducted in patients from northwest China, a relatively undeveloped area. Besides these factors, the impact of doctors’ specialty on the therapy choices should not be ignored 21.…”

Missing the obvious: psychosocial obstacles in Veterans with hepatocellular carcinoma

“…Veterans are also likely to survive on an average lower income; however, a direct comparison is difficult to make with the general population given the lack of reported financial income in these patients. Many studies have consistently found that patients of lower socioeconomic status have poorer survival outcomes after HCC treatment …”

“…Many studies have consistently found that patients of lower socioeconomic status have poorer survival outcomes after HCC treatment. 14,17,18,21,26 One-third of the cohort had a history of homelessness. Homelessness is a prevalent issue in the Veteran population.…”

“…7,8,25 As cancer treatment continues to evolve, clinicians taking care of Veterans not only need to consider the disease process but should also be aware of the psychological and socioeconomic issues these patients face. With respect to HCC, these issues are commonly evaluated when considering transplantation 26 ; however, they are less often investigated when a patient is being assessed for surgical resection and intra-arterial therapies. The purpose of this study was to identify and quantify psychosocial and economic challenges in a Veteran cohort being treated for HCC.…”

Regulations' Impact on Donor and Recipient Selection for Liver Transplantation: How Should Outcomes be Measured and MELD Exception Scores be Considered?

“…The current systems have been shown to overestimate the risk of death from HCC, leading to relative overtransplantation of these patients at the expense of patients without malignancies [33]. The population of patients with HCC also tends to be better insured and of higher socioeconomic status [34], which exacerbates the existing economic disparities in access. HCC patients may, in fact, be transplanted too quickly, and posttransplant survival appears to be improved by waiting longer for a liver and selecting patients with less aggressive disease and lower chance of recurrence [35].…”