Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and has an increasing incidence in the United States.1 Prognosis for patients with HCC largely depends on tumor stage at diagnosis, with curative options only available for patients diagnosed at an early stage.2 Surveillance at 6-month intervals is recommended in patients with cirrhosis to detect HCC at an early stage.3 Despite the availability of efficacious surveillance tests, only 40% of patients with HCC are diagnosed at an early stage nationally.4,5 Tumor stage at diagnosis can be influenced by several factors in clinical practice, including low screening rates and delays in follow-up of abnormal screening tests.6-10
Underuse and/or delays in treatment have also been described as a potential cause of poor cancer outcomes.11-16 The transition from diagnosis to treatment is a complex process in clinical practice, with several steps that are prone to delays and/or failure. Providers must determine the optimal treatment and refer patients to the appropriate provider, the health care system must schedule these appointments, and patients must adhere to these recommendations. This process may be particularly difficult in patients with HCC given primary care providers’ lack of familiarity with the wide array of potential treatment options, each delivered by different providers. For patients diagnosed with HCC, delays as little as 3 months in therapeutic follow-up can allow for significant tumor growth and potentially lead to decreased options for effective treatment.17
Although prior studies have shown underuse of appropriate treatment among patients with HCC, no studies have provided an in-depth analysis of the prevalence and clinical impact of therapeutic delays.18,19 The primary goals of this study were to characterize and identify factors associated with underuse and delays in treatment among a cohort of patients with HCC.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. This work was conducted with support from UT-STAR, NIH/NCATS Grant Number KL2 TR000453, NIH/NCATS Grant UL1-TR000451, and the ACG Junior Faculty Development Award awarded to Dr. Singal. Dr. Waljee’s research is funded by a VA HSR&D CDA-2 career development award 1IK2HX000775. The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, the University of Texas Southwestern Medical Center and its affiliated academic and health centers, the National Center for Advancing Translational Sciences, the Veterans Affairs, or the National Institutes of Health.
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