Racial, ethnic disparities in patients with HCC reveal need to reduce barriers to care
Among patients newly diagnosed with hepatocellular carcinoma, there are significant racial and ethnic differences in barriers to care, according to survey results published in Clinical Gastroenterology and Hepatology.
“We found patients with HCC have notable racial and ethnic differences in health literacy, medical mistrust, and barriers to care, which may partly explain observed disparities in HCC presentation and prognosis,” Amit G. Singal, MD, MS, from UT Southwestern Medical Center, told Healio. “Our data highlight a need for interventions to improve provider-patient communication and reduce patient barriers to care.”
Surveys on barrier to HCC care
Singal and colleagues identified 812 patients, aged 18 years and older and recently diagnosed with HCC, to complete two surveys: a baseline survey during the patients’ first clinic visit after HCC diagnosis and before receiving treatment and a follow-up survey 1 to 3 months later. Of those recruited, 484 completed the baseline survey and 257 completed the follow-up survey. Investigators also used electronic medical records to review patient demographics and clinical information, including severity of cirrhosis, cirrhosis etiology and Barcelona Clinic Liver Cancer (BCLC) tumor stage.
The median age of participants was 64 years and 77.5% were men. Researchers further identified patients by race and ethnicity (42.4% Hispanic, 37.6% non-Hispanic white and 15.3% non-Hispanic Black), as well as liver disease etiology (42.6% hepatitis C, 24.9% alcohol-associated disease and 18.4% nonalcoholic fatty liver disease). More than half of patients (54.5%) were diagnosed with early-stage HCC, while 18.5% had BCLC stage B, 23.5% had BCLC stage C and 3.5% had BCLC stage D.
Race, ethnic differences in HCC care
According to the study, 66.1% of patients reported frequent concern over their HCC diagnosis and cited several barriers to care, including concerns about discomfort during treatment (42.8%), concerns about time commitment while undergoing treatment (31.1%), uncertainty about their diagnosis (22%) and doubts about whether treatment was necessary (11.7%).
Compared with white patients, there was a significantly higher proportion of Hispanic and Black patients who were concerned about time commitment (13.5% vs. 48.7% and 21.1%, respectively; P < .001); expressed uncertainty about their HCC diagnosis (12.1% vs. 30.4% and 20.5%; P = .02); and had doubts about needing treatment (5.4% vs. 13.8% and 20%; P = .01).
Singal and colleagues found that 70.3% of patients reported at least good ability to read and 54.6% reported confidence in completing medical forms. However, researchers identified racial and ethnic differences in health literacy, with only 48.5% of Hispanic and 50% of Black patients reporting confidence in filling out medical forms, compared with 63.2% of white patients (P = .01). In addition, compared with white patients, Hispanic and Black patients were more likely to lack trust in their doctor (1.7% vs. 6.5% and 6%, respectively; P < .001); feel reluctant to confide in their doctor (0.6% vs. 8% and 11.6%; P < .001); express concern that their doctor did not take their medical complaints seriously (5.8% vs. 8.1% and 27.5%; P < .001); and report suspicion about information they receive from their doctor (4% vs. 8.1% and 18.6%; P < .001)).
Researchers also noted that while 39.8% of patients expressed concern about paying medical bills, only 14.6% of patients said their family made financial sacrifices after HCC diagnosis. However, only 10.3% of patients reported either delaying or not getting care, despite patient-reported barriers. These findings were consistent among white, Hispanic and Black patients.
“Barriers to care have been associated with receipt of HCC surveillance, and future studies are needed to link these patient-reported factors to downstream outcomes, such
Singal and colleagues wrote. “Overall, our data highlight the need to develop and test interventions aimed at addressing implicit bias, improving provider-patient communication and reducing patient barriers to HCC medical care.”