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Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

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Journal of Gastrointestinal Surgery

Abstract

Background

Management of hepatocellular carcinoma (HCC) often involves many subspecialist providers, as well as a broad range of treatment options. This study sought to evaluate referral and treatment patterns among patients with HCC at a large academic medical center.

Methods

Data from our cancer registry between 2003–2011 were abstracted on 394 patients who were primarily diagnosed/treated for HCC at Johns Hopkins Hospital (JHH); data on patients who were diagnosed/treated with HCC elsewhere and who received secondary treatment at JHH (n = 391) were also abstracted for comparison purposes.

Results

Among the main cohort, the most common specialties to be consulted were surgery (n = 225, 57.1 %), gastroenterology (n = 225, 57.1 %), and interventional radiologist (n = 206, 52.3 %), while only 96 (24.4 %) were referred to medical oncology. Factors associated with surgical consultation included younger age (odds ratio (OR) 3.35, 95 % CI 1.62–6.92), tumor size <5 cm (OR 1.82, 1.09–3.02), and unilobar disease (OR 2.94, 1.31–6.59) (all P < 0.05). Patients initially diagnosed/treated elsewhere had larger tumors (4 vs. 6 cm), bilateral disease (19.2 vs. 26.8 %), and were more likely to be seen by interventional radiology (all P < 0.05)

Conclusions

Most patients were seen by surgeons, gastroenterologists, or interventional radiologists, with only a minority being seen by medical oncologists. Referral patterns depended on patient-level factors, as well as extent of disease.

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References

  1. Bruix J, Sherman M. American association for the study of liver diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020-2.

    Article  PubMed  Google Scholar 

  2. El-Serag HB. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res. 2007;37 Suppl 2S88-94.

  3. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the US from 1975 to 2005. J Clin Oncol. 2009;27(9):1485-91.

    Article  PubMed  Google Scholar 

  4. Thomas MB, Zhu AX. Hepatocellular carcinoma: the need for progress. J Clin Oncol. 2005;23(13):2892-9.

    Article  PubMed  Google Scholar 

  5. Nathan H, Bridges JF, Schulick RD, Cameron AM, Hirose K, Edil BH, Wolfgang CL, Segev DL, Choti MA, Pawlik TM. Understanding surgical decision making in early hepatocellular carcinoma. J Clin Oncol. 2011;29(6):619-25.

    Article  PubMed  Google Scholar 

  6. Nathan H, Segev DL, Bridges JF, Massie AB, Cameron AM, Hirose K, Schulick RD, Choti MA, Pawlik TM. Influence of nonclinical factors on choice of therapy for early hepatocellular carcinoma. Ann Surg Oncol. 2013;20(2):448-56.

    Article  PubMed  Google Scholar 

  7. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology - Hepatobiliary Cancers. Version 2. 2012.

  8. El-Serag HB, Siegel AB, Davila JA, Shaib YH, Cayton-Woody M, McBride R, McGlynn KA. Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: a population-based study. Journal of Hepatology. 2006;44(1):158-166.

    Article  PubMed  Google Scholar 

  9. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35(3):519-24.

    Article  PubMed  Google Scholar 

  10. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence-SEER 17 Regs Public Use, Nov. 2010 Sub (2000-2008)-Linked to County Attributes-Total US, 1969-2008 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2011.

  11. Nathan H, Hyder O, Mayo SC, Hirose K, Wolfgang CL, Choti MA, Pawlik TM. Surgical Therapy for Early Hepatocellular Carcinoma in the Modern Era: A 10-Year SEER-Medicare Analysis. Ann Surg. 2013.

  12. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Medical Care. 2009;47(6):626-633.

    Article  PubMed  Google Scholar 

  13. Reynolds GA, Chitnis JG, Roland MO. General practitioner outpatient referrals: do good doctors refer more patients to hospital? BMJ. 1991;302(6787):1250-2.

    Article  PubMed  CAS  Google Scholar 

  14. Franks P, Clancy CM. Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance. J Fam Pract. 1997;45(1):47-53.

    PubMed  CAS  Google Scholar 

  15. Steyerberg EW, Neville B, Weeks JC, Earle CC. Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2007;25(17):2389-96.

    Article  PubMed  Google Scholar 

  16. Mandl LA. Determining who should be referred for total hip and knee replacements. Nat Rev Rheumatol. 2013.

  17. Haymart MR, Banerjee M, Yang D, Stewart AK, Griggs JJ, Sisson JC, Koenig RJ. Referral Patterns for Patients with High-Risk Thyroid Cancer. Endocrine Practice. 2013;1-19.

  18. Zhang J, Mavros MN, Cosgrove D, Hirose K, Herman JM, Smallwood-Massey S, Karnel I, Gurakar A, Anders R, Cameron A. Impact of a single-day multidisciplinary clinic on the management of patients with liver tumors. Current Oncology. 2013;20(2):e123.

    Article  PubMed  CAS  Google Scholar 

  19. Cance WG, Stewart AK, Menck HR. The National Cancer Data Base Report on treatment patterns for hepatocellular carcinomas: improved survival of surgically resected patients, 1985-1996. Cancer. 2000;88(4):912-20.

    Article  PubMed  CAS  Google Scholar 

  20. Bufalino VJ, Masoudi FA, Stranne SK, Horton K, Albert NM, Beam C, Bonow RO, Vern Davenport RL Girgus M, Ronarow GC, Krumholz HM, Legnini MW, Lewis WR, Nichol G, Peterson ED, Rumsfeld JS, Schwamm LH, Shahian DM, Spertus JA, Woodard PK, Yancy CW. The American Heart Association’s recommendations for expanding the applications of existing and future clinical registries: a policy statement from the American Heart Association. Circulation. 2011;123(19):2167-79.

    Article  PubMed  Google Scholar 

  21. Facility Oncology Registry Data Standards. Chicago, IL: Commission on Cancer. 2012.

  22. Gliklich R, Dreyer N. Registries for Evaluating Patient Outcomes. Agency for Healthcare Research and Quality, Rockville, MD. 2010.

    Google Scholar 

  23. Kurtz JE, Heitz D, Enderlin P, Imbert F, Nehme H, Bergerat JP, Dufour P. Geriatric oncology, general practitioners and specialists: current opinions and unmet needs. Crit Rev Oncol Hematol. 2010;75(1):47-57.

    Article  PubMed  Google Scholar 

  24. Shah SA, Smith JK, Li Y, Ng SC, Carroll JE, Tseng JF. Underutilization of therapy for hepatocellular carcinoma in the medicare population. Cancer. 2011;117(5):1019-26.

    Article  PubMed  Google Scholar 

  25. Nathan H, Frederick W, Choti MA, Schulick RD, Pawlik TM. Racial disparity in surgical mortality after major hepatectomy. J Am Coll Surgeons. 2008;207(3):312-319.

    Article  Google Scholar 

  26. Andaya AA, Enewold L, Zahm SH, Shriver CD, Stojadinovic A, McGlynn KA, Zhu K. Race and Colon Cancer Survival in an Equal-Access Healthcare System. Cancer Epidem Biomar. 2013.

  27. Spencer BA, Insel BJ, Hershman DL, Benson MC, Neugut AI. Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer. Support Care Cancer. 2013;1-9.

  28. Del Carmen MG, Avila-Wallace M. Effect of Health Care Disparities on Screening. Clin Obstet Gynecol. 2013;56(1):65-75.

    Article  PubMed  Google Scholar 

  29. Luo R, Giordano SH, Zhang DD, Freeman J, Goodwin JS. The role of the surgeon in whether patients with lymph node-positive colon cancer see a medical oncologist. Cancer. 2007;109(5):975-82.

    Article  PubMed  Google Scholar 

  30. Kirkpatrick HM, Aitelli CL, Qin H, Becerra C, Lichliter WE, McCollum AD. Referral patterns and adjuvant chemotherapy use in patients with stage II colon cancer. Clin Colorectal Cancer. 2010;9(3):150-6.

    Article  PubMed  Google Scholar 

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Correspondence to Timothy M. Pawlik.

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Stacy, S., Hyder, O., Cosgrove, D. et al. Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US. J Gastrointest Surg 17, 1600–1608 (2013). https://doi.org/10.1007/s11605-013-2253-y

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  • DOI: https://doi.org/10.1007/s11605-013-2253-y

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