Atif Zaman, MD, MPH reviewing Serper M et al. Gastroenterology 2017 Mar 7.

Seeing a hepatologist, oncologist, or surgeon within 30 days of diagnosis and review by a tumor board were also linked with lower mortality.

Curative therapies for hepatocellular carcinoma (HCC) are underutilized, possibly because of the complex nature of determining the ideal treatment modality.

In the current retrospective cohort study, researchers assessed the effect of multiple care delivery variables on the likelihood of receiving active HCC therapy and survival in 3988 patients treated for HCC at 128 U.S. Veterans Administration (VA) hospitals. Information on specialties of providers involved in HCC care and occurrence of a tumor board discussion were manually extracted via chart review. HCC therapies included liver transplantation, surgical resection, liver-directed therapies, and systemic chemotherapy.

Seventy-four percent of patients received active HCC therapy, 54% saw more than one type of specialist, and 34% had their cases discussed by a multidisciplinary tumor board. Care delivery factors associated with a higher likelihood of receiving active HCC treatment were receiving care at an academically affiliated VA hospital (odds ratio, 1.97) and receiving a multispecialist evaluation (OR, 1.60) but not being reviewed by a multidisciplinary tumor board. Care delivery factors associated with reduced mortality risk were subspecialist care by hepatologists (hazard ratio, 0.70), oncologists (HR, 0.82), or surgeons (HR, 0.79) within 30 days of HCC diagnosis and review by a tumor board (HR, 0.80). As expected, receiving active HCC therapy led to reduced mortality risk.

CITATION(S):

Serper M et al. Association of provider specialty and multi-disciplinary care with hepatocellular carcinoma treatment and mortality. Gastroenterology 2017 Mar 7; [e-pub]. 

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