HCC treatment underutilized in the US
The number of patients in the US with hepatocellular carcinoma who undergo both any or specifically curative treatment is low, including those diagnosed at an early stage, according to recent results.
Researchers performed a systematic review of 24 studies published in the US between January 1989 and March 2013 collected from the Medline database. All studies included data on treatment for hepatocellular carcinoma, along with sociodemographic information for both treated and untreated participants.
Across 16 studies of a total of 24,237 patients that included data on receipt of either curative or noncurative treatment, treatment rates ranged from 28% to 85% for a pooled rate of 52.8%. Among the 23 studies that included data on curative treatment in 50,769 patients, rates ranged from 14% to 51%, with a pooled rate of 21.8%.
Data on patients with early-stage HCC was reported in 18 studies, with 37.9% of 32,884 patients diagnosed at an early stage. Among these patients, the curative treatment rate was 59%.
Five studies indicated that advanced age was negatively predictive of treatment, while gender had no effect across the majority of studies. Race had a significant impact on treatment, especially curative treatment, in five studies, with African-American patients significantly less likely to be treated. Participants with lower socioeconomic status also had consistently lower treatment rates in four studies with evaluable data, with one study indicating that patients without insurance (OR=0.05, 0.01-0.37) and Medicaid recipients (OR=0.32, 0.15-0.69) were significantly less likely to undergo surgery than patients with private insurance (95% CI for both).
Amit G. Singal
“Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low,” researcher Amit G. Singal, MD, MS, assistant professor at University of Texas Southwestern Medical Center in Dallas, told Healio.com. “Our study also highlights the presence of significant socio-demographic disparities, with the lowest treatment rates among non-Caucasians and patients of low SES. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.”
Disclosure: Researchers Amit G. Singal and Adam Yopp serve on the speaker bureau for Bayer and Onyx Pharmaceuticals.