Cirrhotic patients with hepatocellular carcinoma have significantly poorer survival when they experience therapeutic delays, according to data presented at the International Liver Cancer Association Annual Conference in Washington, DC.
In a retrospective cohort study, researchers evaluated 267 patients with cirrhosis who were diagnosed with hepatocellular carcinoma (HCC) at an urban hospital between January 2005 and June 2012.
Amit G. Singal
“Although prior studies have shown underuse of appropriate treatment among patients with HCC, our study was the first to provide an in-depth analysis of the prevalence and clinical impact of therapeutic delays,” Amit G. Singal, MD, MS, assistant professor at University of Texas Southwestern Medical Center in Dallas, told Healio.com.
Among evaluated patients, 62% underwent treatment for HCC, with a median time to treatment of 1.7 months. Treatment was delayed in 31% of cases. Multivariate analysis indicated significant associations between lower treatment utilization rates and black race (OR=0.55; 95% CI, 0.31-0.99), Child-Turcotte-Pugh (CTP) class (OR=0.49; 95% CI, 0.28-0.84) and tumor stage (OR=0.48; 95% CI, 0.36-0.65). Treatment delay was associated with increased risk for ascites (HR=2.8; 95% CI, 1.3-6.1) and need for transarterial chemoembolization (HR=4.8; 95% CI, 1.8-12.5).
Survival rates among patients whose treatment was delayed were 63.7% at 1 year and 50.1% at 2 years, compared with 89.8% and 64.5%, respectively, among those who did not experience delay. Treatment delay (HR=0.5; 95% CI, 0.3-0.84) and treatment underutilization (HR=0.33; 95% CI, 0.24-0.46) were significantly associated with worse survival after adjustment for CTP class and tumor stage.
“We believe that therapeutic delays are related to the multiple interfaces between providers as patients transition from diagnosis to treatment,” Singal said. “Our study found that these therapeutic delays are worrisome, as they are associated with an increased risk of mortality. … Multidisciplinary care was able to significantly reduce the likelihood of therapeutic delays.”
Disclosure: The researchers report no relevant financial disclosures.
For more information:
Singal A. P-211: Therapeutic Delays Lead to Worse Survival Among Patients with Hepatocellular Carcinoma. Presented at: The International Liver Cancer Association Annual Conference 2013; Sept. 13-15, Washington, DC.