Grace Duininck1, Alexandra G Lopez-Aguiar1, Rachel M Lee1, Lesley Miller2, Sean Dariushnia3, Christina Wu4, Olatunji B Alese4, Jolinta Y Lin5, Joel Wedd6, Andrew Adams7, Shishir K Maithel1, Maria C Russell1. 1. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia. 2. Department of Internal Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. 3. Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University, Atlanta, Georgia. 4. Department of Hematology and Oncology, Emory University, Atlanta, Georgia. 5. Department of Radiation Oncology, Emory University, Atlanta, Georgia. 6. Department of Internal Medicine, Division of Digestive Diseases, Transplant Hepatology, Emory University, Atlanta, Georgia. 7. Department of Surgery, Division of Transplantation, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown. METHODS: Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. RESULTS: Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001). CONCLUSION: Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.
BACKGROUND: Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown. METHODS:Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCVpatients for HCC were also examined. RESULTS: Of 204 HCCpatients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCVpatients screened for HCC had earlier stage disease (P = .001). CONCLUSION: Implementation of a DMT at GMH is associated with increased HCCpatients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCVpatients at risk for HCC.
Authors: Gretchen C Edwards; Sandra L Wong; Maria C Russell; Emily R Winslow; Virginia O Shaffer; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2022-03-22 Impact factor: 3.452
Authors: Michael K Turgeon; Rachel M Lee; Adriana C Gamboa; Adam Yopp; Emily L Ryon; Neha Goel; Annie Wang; Ann Y Lee; Sommer Luu; Cary Hsu; Eric Silberfein; Shishir K Maithel; Maria C Russell Journal: HPB (Oxford) Date: 2020-08-07 Impact factor: 3.647