Variation in hepatocellular carcinoma outcomes due to access barriers: study

Thursday, 24 Jun 2021

A Queensland study of patients with hepatocellular carcinoma (HCC) has confirmed the impact of geographical inequities on health outcomes

The retrospective study of 1,651 patients with HCC found those living in rural and remote areas were significantly less likely to receive surgical resection for their cancer compared with patients living in metropolitan areas (9% v 13%; p=0.021).

The study, published in JGH Open, also found patients who lived outside of a major city had 33% fewer months of survival compared with those living in major cities (95% CrI 0.55–0.80).

The median survival time after HCC diagnosis was nine months.

“Living in rural, remote areas could be associated with lesser opportunities to engage in surveillance for patients at risk of developing HCC such as those with cirrhosis,” the authors noted.

They said distance may prohibit patients living outside major cities accessing specialty liver clinics, which “…contributes to lack of access to good quality screening such as blood tests and ultrasound, loss to follow-up, and late diagnosis of HCC…”

The study found chronic HBV (54.8%) was the leading underlying aetiology for HCC in migrants while alcohol misuse (43.7%) was the most prevalent aetiology in other Australians.

Despite the different aetiologies, the median age at diagnosis of HCC was similar in both subgroups (66.7 v 65.5 years).

“Hepatitis C infection was the second most prevalent underlying aetiology for HCC in both migrants (34.2%) and other Australian (34.8%) patients.”

Chronic HCV (77.8%) was also the most common reason for liver transplantation.

“Although direct-acting antiviral treatment for HCV has resulted in a significant decline in the incidence of HCV infection, the risk of developing HCC remains after a sustained virologic response,” the study said.

There was no statistically significant difference in the number of months survived after HCC diagnosis between migrants and other Australians.

“Patients who presented with undifferentiated HCC had significantly fewer months of survival (TR = 0.30, 95% CrI 0.23–0.39) compared with patients presented with well-differentiated tumour.”

Older age at diagnosis was also associated with shorter survival time – patients 60–69 years had 28% fewer months of survival and patients ≥70 years of age had 58% fewer months of survival compared <60 year olds.

The study also noted that patients in remote and rural areas were more likely to be exposed to environmental risk factors including aflatoxin, which was known to accelerate the progression of HCC and cause earlier onset and higher mortality.

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