The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study
Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was p...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-01-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/28/1/42 |
| _version_ | 1797520736839008256 |
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| author | Irene S. Yu Shiru L. Liu Valeriya Zaborska Tyler Raycraft Sharlene Gill Howard Lim Janine M. Davies |
| author_facet | Irene S. Yu Shiru L. Liu Valeriya Zaborska Tyler Raycraft Sharlene Gill Howard Lim Janine M. Davies |
| author_sort | Irene S. Yu |
| collection | DOAJ |
| description | Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; <i>p</i> < 0.001), Child–Pugh A (94% vs. 83% vs. 80%; <i>p</i> = 0.022), and hepatitis B (37% vs. 15% vs. 4%; <i>p</i> < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; <i>p</i> = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; <i>p</i> = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; <i>p</i> < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; <i>p</i> = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival. |
| first_indexed | 2024-03-10T08:00:52Z |
| format | Article |
| id | doaj.art-42ecc8708a59439b9b894ceb322b7a25 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-10T08:00:52Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-42ecc8708a59439b9b894ceb322b7a252023-11-22T11:29:23ZengMDPI AGCurrent Oncology1198-00521718-77292021-01-0128139640410.3390/curroncol28010042The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based StudyIrene S. Yu0Shiru L. Liu1Valeriya Zaborska2Tyler Raycraft3Sharlene Gill4Howard Lim5Janine M. Davies6Department of Medical Oncology, BC Cancer Vancouver, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer Fraser Valley, Surrey, BC V3V 1Z2, CanadaFaculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, CanadaFaculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, CanadaDepartment of Medical Oncology, BC Cancer Vancouver, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer Vancouver, Vancouver, BC V5Z 4E6, CanadaDepartment of Medical Oncology, BC Cancer Vancouver, Vancouver, BC V5Z 4E6, CanadaBackground: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; <i>p</i> < 0.001), Child–Pugh A (94% vs. 83% vs. 80%; <i>p</i> = 0.022), and hepatitis B (37% vs. 15% vs. 4%; <i>p</i> < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; <i>p</i> = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; <i>p</i> = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; <i>p</i> < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; <i>p</i> = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.https://www.mdpi.com/1718-7729/28/1/42hepatocellular carcinomaHCCurbanruraldisparity |
| spellingShingle | Irene S. Yu Shiru L. Liu Valeriya Zaborska Tyler Raycraft Sharlene Gill Howard Lim Janine M. Davies The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study Current Oncology hepatocellular carcinoma HCC urban rural disparity |
| title | The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study |
| title_full | The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study |
| title_fullStr | The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study |
| title_full_unstemmed | The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study |
| title_short | The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study |
| title_sort | impact of geography in hepatocellular carcinoma a retrospective population based study |
| topic | hepatocellular carcinoma HCC urban rural disparity |
| url | https://www.mdpi.com/1718-7729/28/1/42 |
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