Clinical Characteristics and Pattern of Care Among Patients Diagnosed With Hepatocellular Carcinoma at a Safety Net Hospital

Abstract

Introduction: Safety net hospitals are an integral part of the United States health care system. Many serve as teaching hospitals affiliated with major academic institutions. They also provide majority of care to the underserved population. Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related mortality in the United States. As a quality improvement project we studied characteristics and pattern of care among patients diagnosed with HCC over a period of one year at a major safety net hospital. Methods: We retrospectively abstracted medical records of patients diagnosed with HCC at Ben Taub General Hospital (Houston, TX) between June 2012 and June 2013. Data was extracted manually from each patient's record to confirm diagnosis, etiology, stage, clinical parameters, receipt of screening, treatment received, and survival. Results: The study included 72 patients, and most were men (78%). The median age at diagnosis was 56 years. The population was racially diverse and consisted of 47% Hispanics, 26% Caucasians, 14% Asians, and 11% African Americans. Hepatitis C was the underlying cause of liver disease in 70%, alcohol abuse in 60%, hepatitis B in 13%, NASH in 3%. Only 19% had been to a gastroenterology or hepatology clinic visit within the 12 months prior to HCC diagnosis. Among the cohort 71% were either Child-Pugh class A or B at diagnosis and eligible for HCC screening prior to diagnosis. However, only 35% of the cohort was diagnosed as a result of guideline-recommended HCC screening; the rest were diagnosed incidentally or prompted by symptoms. Most patients presented with advanced stage disease: 49% with Barcelona Clinic Liver Cancer stage C and 34% with stage D. Among the cohort only 50% received any treatment. Survival at one year was 39%. Conclusion: The data from this cohort indicates that about two-thirds of patients diagnosed with HCC at a safety net hospital were of ethnic minority. A high proportion presented with advanced stage disease at diagnosis. This was most likely mediated by lack of guideline-based HCC screening prior to diagnosis. There is urgent need to survey awareness about HCC screening among primary care providers and also increase referral to specialty clinics.