Ashwin Rao1, Nicole E Rich1,2, Jorge A Marrero1,3, Adam C Yopp2,4, Amit G Singal1,2,3. 1. 1Department of Internal Medicine. 2. 2Harold C. Simmons Comprehensive Cancer Center. 3. 3Department of Population and Data Sciences, and. 4. 4Department of Surgery, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas.
Abstract
BACKGROUND: Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC. METHODS: We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival. RESULTS: Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18-94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29-74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60-1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality. CONCLUSIONS: Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.
BACKGROUND: Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC. METHODS: We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival. RESULTS: Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18-94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29-74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60-1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality. CONCLUSIONS: Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.
Authors: Yi-Te Lee; Amit G Singal; Marie Lauzon; Vatche G Agopian; Michael Luu; Mazen Noureddin; Tsuyoshi Todo; Irene K Kim; Marc L Friedman; Kambiz Kosari; Nicholas N Nissen; Lewis R Roberts; Julie K Heimbach; Gregory J Gores; Ju Dong Yang Journal: Cancer Date: 2022-08-23 Impact factor: 6.921
Authors: Rajalakshmi Govalan; Michael Luu; Marie Lauzon; Kambiz Kosari; Joseph C Ahn; Nicole E Rich; Nicholas Nissen; Lewis R Roberts; Amit G Singal; Ju Dong Yang Journal: Hepatol Commun Date: 2021-08-25
Authors: Amit G Singal; Hye-Chung Kum; Nikita Sandeep Wagle; Sulki Park; David Washburn; Robert L Ohsfeldt; Nicole E Rich Journal: Hepatol Commun Date: 2021-11-19
Authors: Neehar D Parikh; Nabihah Tayob; Taim Al-Jarrah; Jennifer Kramer; Jennifer Melcher; Donna Smith; Patrick Marquardt; Po-Hong Liu; Runlong Tang; Fasiha Kanwal; Amit G Singal Journal: JAMA Netw Open Date: 2022-07-01