1. Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality
- Author
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Serper, Marina, Taddei, Tamar H, Mehta, Rajni, D'Addeo, Kathryn, Dai, Feng, Aytaman, Ayse, Baytarian, Michelle, Fox, Rena, Hunt, Kristel, Goldberg, David S, Valderrama, Adriana, Kaplan, David E, and VOCAL Study Group
- Subjects
Male ,Liver Cancer ,Time Factors ,Population ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Kaplan-Meier Estimate ,Practice Patterns ,Risk Assessment ,Paediatrics and Reproductive Medicine ,Rare Diseases ,Risk Factors ,Clinical Research ,Integrated ,Odds Ratio ,Humans ,Proportional Hazards Models ,Retrospective Studies ,Aged ,Cancer ,Patient Care Team ,Surgeons ,Oncologists ,Chi-Square Distribution ,Physicians' ,Gastroenterology & Hepatology ,Risk Factor ,Liver Disease ,Carcinoma ,Liver Neoplasms ,Gastroenterologists ,Neurosciences ,Hepatocellular ,Middle Aged ,Health Services ,Quality ,United States ,United States Department of Veterans Affairs ,Treatment Outcome ,Logistic Models ,Good Health and Well Being ,Multivariate Analysis ,Female ,VOCAL Study Group ,Digestive Diseases ,Delivery of Health Care ,Specialization - Abstract
Background & aimsLittle is known about provider and health system factors that affect receipt of active therapy and outcomes of patients with hepatocellular carcinoma (HCC). We investigated patient, provider, and health system factors associated with receipt of active HCC therapy and overall survival.MethodsWe performed a national, retrospective cohort study of all patients diagnosed with HCC from January 1, 2008 through December 31, 2010 (n= 3988) and followed through December 31 2014 who received care through the Veterans Administration (128 centers). Outcomes were receipt of active HCC therapy (liver transplantation, resection, local ablation, transarterial therapy, or sorafenib) and overall survival.ResultsIn adjusted analyses, receiving care at an academically affiliated Veterans Administration hospital (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.60-2.41) or a multi-specialist evaluation (OR, 1.60; 95% CI, 1.15-2.21), but not review by a multidisciplinary tumor board (OR, 1.19; 95% CI, 0.98-1.46), was associated with a higher likelihood of receiving active HCC therapy. In time-varying Cox proportional hazards models, liver transplantation (hazard ratio [HR], 0.22; 95% CI, 0.16-0.31), liver resection (HR, 0.38; 95% CI, 0.28-0.52), ablative therapy (HR,0.63; 95% CI, 0.52-0.76), and transarterial therapy (HR,0.83; 95% CI, 0.74-0.92) were associated with reduced mortality. Subspecialist care by hepatologists (HR, 0.70; 95% CI, 0.63-0.78), medical oncologists (HR, 0.82; 95% CI, 0.74-0.91), or surgeons (HR, 0.79; 95% CI, 0.71-0.89) within30 days of HCC diagnosis, and review by a multidisciplinary tumor board (HR, 0.83; 95% CI,0.77-0.90), were associated with reduced mortality.ConclusionsIn a retrospective cohort study of almost 4000 patients with HCC cared for at VA centers, geographic, provider, and system differences in receipt of active HCCtherapy are associated with patient survival. Multidisciplinary methods of care delivery for HCC should be prospectively evaluated and standardized to improve access to HCC therapy and optimize outcomes.
- Published
- 2017