The impact of social risk factors on the presentation, treatment and survival of patients with hepatocellular carcinoma at an urban, academic safety-net hospital.

Autor: Romatoski K; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Chung S; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Dia M; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Papageorge MV; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Woods AP; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Cherukuri P; Department of Gastroenterology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Canakis A; Department of Gastroenterology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Gupta A; Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., LeBedis C; Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Sachs TE; Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. Electronic address: Teviah.Sachs@bmc.org., Mohanty A; Department of Gastroenterology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. Electronic address: arpan.mohanty@bmc.org.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2023 Aug; Vol. 226 (2), pp. 278-283. Date of Electronic Publication: 2023 May 25.
DOI: 10.1016/j.amjsurg.2023.05.021
Abstrakt: Background: Vulnerable populations have worse hepatocellular carcinoma (HCC) outcomes. We sought to understand if this could be mitigated at a safety-net hospital.
Methods: A retrospective chart review of HCC patients was conducted (2007-2018). Stage at presentation, intervention and systemic therapy were analyzed (Chi-square for categorical variables and Wilcoxon tests for continuous variables) and median survival calculated by Kaplan-Meier method.
Results: 388 HCC patients were identified. Sociodemographic factors were similar for stage at presentation, except insurance status (diagnosis at earlier stages for commercial insurance and later stages for safety-net/no insurance). Higher education level and origin of mainland US increased intervention rates for all stages. Early-stage disease patients had no differences in receipt of intervention or therapy. Late-stage disease patients with higher education level had increased intervention rates. Median survival was not impacted by any sociodemographic factor.
Conclusion: Urban safety-net hospitals with a focus on vulnerable patient populations provide equitable outcomes and can serve as a model to address inequities in HCC management.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose. Kelsey Romatoski and Sophie Chung are supported by the Health Resources Services Administration's National Research Service Award Grant Number T32HP10028. The content is solely the responsibility of the authors and does not necessarily represent official views of the supporting institutions.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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