Opportunities to Improve Care of Hepatocellular Carcinoma in Vulnerable Patient Populations
| Autor: | Michael J. Edwards, Derek E. Go, Dennis J. Hanseman, Richard S. Hoehn, Vikrom K. Dhar, Shimul A. Shah |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular Databases Factual medicine.medical_treatment Liver transplantation Vulnerable Populations 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Carcinoma Hepatectomy Humans Healthcare Disparities Practice Patterns Physicians' Intensive care medicine Survival analysis Aged Retrospective Studies Medically Uninsured business.industry Medicaid Liver Neoplasms Cancer Retrospective cohort study Odds ratio Health Status Disparities Middle Aged medicine.disease Survival Analysis United States Liver Transplantation Logistic Models Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Female business Safety-net Providers Follow-Up Studies |
| Zdroj: | Journal of the American College of Surgeons. 224(4) |
| ISSN: | 1879-1190 |
| Popis: | Hepatocellular carcinoma (HCC) patients with Medicaid or no health insurance have inferior survival compared with privately insured patients. Safety-net hospitals that care for these patients are often criticized for their inferior outcomes. We hypothesized that HCC survival was related to appropriate surgical management.The American College of Surgeons National Cancer Database was queried for patients diagnosed with HCC (n = 111,481) from 1998 to 2010. Hospitals were stratified according to safety-net burden, defined as the percentage of patients with Medicaid or no insurance. The highest quartile, representing safety-net hospitals, was compared with lower-burden hospitals with regard to patient demographics, cancer presentation, surgical management, and survival.Patients at safety-net hospitals were less often white, had less income and education, but presented with similar stage HCC. Safety-net hospital patients were less likely to receive surgery (odds ratio 0.77; p0.01), and among curable patients (stages 1 and 2) who underwent surgical intervention, liver transplantation and resection were performed less often at safety-net hospitals than at other hospitals (50.7% vs 66.7%). Procedure-specific mortality rates were also higher at safety net hospitals (p0.01). However, multivariate analysis adjusting for cancer stage and type of surgery revealed similar survival for safety-net hospital patients who had surgery and survived for longer than 30 days (p = 0.73).Vulnerable patients with HCC are commonly treated at safety-net hospitals, are less likely to receive curative surgery, and have worse short-term outcomes. However, safety-net patients who can endure liver surgery have a similar prognosis as patients at nonsafety-net hospitals. Providing equal access to surgery may improve survival for vulnerable populations of HCC patients. |
| Databáze: | OpenAIRE |
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