Document Detail


Referral and receipt of treatment for hepatocellular carcinoma in United States veterans: effect of patient and nonpatient factors.
MedLine Citation:
PMID:  23359313     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The delivery of treatment for hepatocellular carcinoma (HCC) could be influenced by the place of HCC diagnosis (hospitalization versus outpatient), subspecialty referral following diagnosis, as well as physician and facility factors. We conducted a study to examine the effect of patient and nonpatient factors on the place of HCC diagnosis, referral, and treatment in Veterans Administration (VA) hospitals in the United States. Using the VA Hepatitis C Clinical Case Registry, we identified hepatitis C virus (HCV)-infected patients who developed HCC during 1998-2006. All cases were verified and staged according to Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We examined factors related to these outcomes using hierarchical logistic regression. These factors included HCC stage, HCC surveillance, physician specialty, and facility factors, in addition to risk factors, comorbidity, and liver disease indicators. Approximately 37.2% of the 1,296 patients with HCC were diagnosed during hospitalization, 31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being seen by a surgeon or oncologist was associated with surveillance (adjusted odds ratio [aOR] = 1.47; 95% CI: 1.20-1.80) and varied by geography (1.74;1.09-2.77). Seeing a surgeon or oncologist was predictive of treatment (aOR = 1.43; 95% CI: 1.24-1.66). There was a significant increase in treatment among patients who received surveillance (aOR = 1.37; 95% CI: 1.02-1.71), were seen by gastroenterology (1.65;1.21-2.24), or were diagnosed at a transplant facility (1.48;1.15-1.90). Conclusion: Approximately 40% of patients were diagnosed during hospitalization. Most patients were not seen by a surgeon or oncologist for treatment evaluation and only 34% received treatment. Only receipt of HCC surveillance was associated with increased likelihood of outpatient diagnosis, being seen by a surgeon or oncologist, and treatment.
Authors:
Jessica A Davila; Jennifer R Kramer; Zhigang Duan; Peter A Richardson; Gia L Tyson; Yvonne H Sada; Fasiha Kanwal; Hashem B El-Serag
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Publication Detail:
Type:  Journal Article     Date:  2013-03-14
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  57     ISSN:  1527-3350     ISO Abbreviation:  Hepatology     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-23     Completed Date:  2013-07-05     Revised Date:  2014-06-23    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1858-68     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Association for the Study of Liver Diseases.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carcinoma, Hepatocellular / epidemiology,  therapy*
Cohort Studies
Disease Progression
Female
Hepatitis C / diagnosis
Humans
Inpatients / statistics & numerical data*
Liver Neoplasms / epidemiology,  therapy*
Logistic Models
Male
Middle Aged
Outpatients / statistics & numerical data*
Referral and Consultation / statistics & numerical data*
Registries
Retrospective Studies
Treatment Outcome
United States / epidemiology
United States Department of Veterans Affairs / statistics & numerical data
Veterans / statistics & numerical data*
Grant Support
ID/Acronym/Agency:
K24 DK078154/DK/NIDDK NIH HHS; P30 CA125123/CA/NCI NIH HHS; R01 CA116845/CA/NCI NIH HHS; T32 DK083266/DK/NIDDK NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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