Background: Psychosocial barriers, including low socioeconomic status, homelessness, alcohol and substance use disorders, and psychiatric disorders are prevalent in US veterans. Our study aims to identify the prevalence of psychosocial barriers in veterans diagnosed with hepatocellular carcinoma (HCC), and their impact on receipt of cancer care. Methods: A retrospective cohort study was performed of all veterans diagnosed with HCC at the William S. Middleton Memorial Veterans' Hospital in Madison, Wisconsin, whose tumor care was coordinated through a multidisciplinary tumor board. Outcomes included receipt of any HCC-specific therapy and overall survival. Results: From January 1, 2007, through December 31, 2016, 149 veterans were diagnosed with HCC. Substance use disorders were reported in 124 (83%) patients, psychiatric illness was documented in 55 (37%) patients, 23 (15%) patients had incomes below the poverty threshold, and 7 (5%) were experiencing homelessness. The mean (SD) distance traveled for care was 207.1 (277.9) km; travel and lodging assistance were accessed by 50 (34%) and 33 (22%) veterans, respectively. Seventy-one patients (48%) had HCC exceeding T2 stage at diagnosis. Curative treatment was offered to 78 (52%) patients, with 127 (85%) receiving any HCC-specific care. Median survival from diagnosis was 727 days (95% CI, 488-966). Conclusions: Psychosocial barriers were common in our veteran cohort. Individualizing care, and coordination of travel and lodging, assisted in enabling high rates of receipt of HCC-specific therapy and improving patient survival.
Background: Psychosocial barriers, including low socioeconomic status, homelessness, alcohol and substance use disorders, and psychiatric disorders are prevalent in US veterans. Our study aims to identify the prevalence of psychosocial barriers in veterans diagnosed with hepatocellular carcinoma (HCC), and their impact on receipt of cancer care. Methods: A retrospective cohort study was performed of all veterans diagnosed with HCC at the William S. Middleton Memorial Veterans' Hospital in Madison, Wisconsin, whose tumor care was coordinated through a multidisciplinary tumor board. Outcomes included receipt of any HCC-specific therapy and overall survival. Results: From January 1, 2007, through December 31, 2016, 149 veterans were diagnosed with HCC. Substance use disorders were reported in 124 (83%) patients, psychiatric illness was documented in 55 (37%) patients, 23 (15%) patients had incomes below the poverty threshold, and 7 (5%) were experiencing homelessness. The mean (SD) distance traveled for care was 207.1 (277.9) km; travel and lodging assistance were accessed by 50 (34%) and 33 (22%) veterans, respectively. Seventy-one patients (48%) had HCC exceeding T2 stage at diagnosis. Curative treatment was offered to 78 (52%) patients, with 127 (85%) receiving any HCC-specific care. Median survival from diagnosis was 727 days (95% CI, 488-966). Conclusions: Psychosocial barriers were common in our veteran cohort. Individualizing care, and coordination of travel and lodging, assisted in enabling high rates of receipt of HCC-specific therapy and improving patient survival.
Authors: Jack Tsai; Bruce Link; Robert A Rosenheck; Robert H Pietrzak Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-04-13 Impact factor: 4.328
Authors: Adam C Yopp; John C Mansour; Muhammad S Beg; Juan Arenas; Clayton Trimmer; Mark Reddick; Ivan Pedrosa; Gaurav Khatri; Takeshi Yakoo; Jeffrey J Meyer; Jacqueline Shaw; Jorge A Marrero; Amit G Singal Journal: Ann Surg Oncol Date: 2013-12-07 Impact factor: 5.344
Authors: L E Kazis; D R Miller; J Clark; K Skinner; A Lee; W Rogers; A Spiro; S Payne; G Fincke; A Selim; M Linzer Journal: Arch Intern Med Date: 1998-03-23
Authors: Fasiha Kanwal; Jennifer R Kramer; Srikar Mapakshi; Yamini Natarajan; Maneerat Chayanupatkul; Peter A Richardson; Liang Li; Roxanne Desiderio; Aaron P Thrift; Steven M Asch; Jinna Chu; Hashem B El-Serag Journal: Gastroenterology Date: 2018-08-23 Impact factor: 22.682
Authors: Lauren A Beste; Steven L Leipertz; Pamela K Green; Jason A Dominitz; David Ross; George N Ioannou Journal: Gastroenterology Date: 2015-08-05 Impact factor: 22.682
Authors: Jessica A Davila; Jennifer R Kramer; Zhigang Duan; Peter A Richardson; Gia L Tyson; Yvonne H Sada; Fasiha Kanwal; Hashem B El-Serag Journal: Hepatology Date: 2013-03-14 Impact factor: 17.425
Authors: Tammy T Chang; Rajiv Sawhney; Alexander Monto; J Ben Davoren; Jacob G Kirkland; Lygia Stewart; Carlos U Corvera Journal: HPB (Oxford) Date: 2008 Impact factor: 3.647