Demographic and Clinicopathologic Factors of Patients With Hepatocellular Carcinoma in a Safety Net Hospital

• Published in: The Journal of surgical research 2020-12, Vol.256, p.374-380
• Main Authors: Luu, Sommer, Hsu, Cary, Silberfein, Eric J.
• Format: Article
• Language: English
• Subjects: Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - economics; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - economics; Chemoembolization, Therapeutic - statistics & numerical data; Disease-Free Survival; Female; Follow-Up Studies; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand - statistics & numerical data; Hepatocellular carcinoma; Humans; Liver - pathology; Liver Neoplasms - diagnosis; Liver Neoplasms - economics; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Liver Transplantation - economics; Liver Transplantation - statistics & numerical data; Male; Mass Screening - organization & administration; Middle Aged; Minority Groups - statistics & numerical data; Neoplasm Staging - economics; Retrospective Studies; Safety net hospital; Safety-net Providers - organization & administration; Safety-net Providers - statistics & numerical data; Socioeconomic Factors; Sorafenib - economics; Sorafenib - therapeutic use
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2020.06.046

Safety net hospitals have historically cared for a disproportionate number of patients of low socioeconomic status, racial and ethnic minorities, and patients with cancer. These innate challenges make safety net hospitals important in understanding how to improve access to cancer care in order to fit the needs of vulnerable patients and ultimately improve their outcomes. The purpose of this study is to characterize the current state and treatment of hepatocellular carcinoma (HCC) at Ben Taub Hospital, a safety net hospital in Houston, Texas. A retrospective chart review was performed to review the demographic characteristics, clinicopathologic data, treatment strategies, and outcomes of HCC patients at Ben Taub Hospital between January 2012 and December 2014. Two-hundred twenty-six men and 78 women with a mean age of 58 y underwent evaluation. Most (87%) were either uninsured or covered by Medicaid. The majority (69%) of patients presented with advanced (stage 2 or more) disease, with 58% of patients presenting with multiple lesions. Of the 40% that presented with a solitary lesion, the average size was 4.97 cm. Transarterial chemoembolization was used in 37% of patients and sorafenib was given to 26% of patients. Five patients underwent successful transplant. One hundred seventeen (38%) patients died of their disease, 25 patients are alive with no evidence of disease, and 159 patients have been lost to follow-up. Most patients with HCC presented to this safety net hospital with advanced disease; however, multiple local and systemic treatments were offered. Screening programs to detect HCC at an earlier stage are essential for successful long-term outcomes in a resource-strapped hospital with limited access to liver transplantation.