Disparities in Hepatocellular Cancer Screening in Cirrhotic Patients With Psychiatric Disorders

Abstract

Background Patients with psychiatric disorders are at an increased risk of developing liver diseases, including hepatocellular carcinoma (HCC). HCC is a leading cause of cancer-related deaths in the United States. The aim of this study was to re-examine the association of psychiatric illness with HCC and assess its impact on screening practices and the outcomes of HCC. Materials and methods We performed a retrospective manual chart review of all patients diagnosed with HCC at a major safety-net hospital in Cleveland, Ohio, from January 2010 to December 2019. Patients were divided into two groups, those with and those without psychiatric illness. The patient characteristics recorded included psychiatric illnesses, etiology of liver disease, radiographic screening intervals, and tumor board recommendations upon initial diagnosis. We analyzed data using Statistical Product and Service Solutions version 26.0 (IBM Corp., Armonk, NY). We analyzed the qualitative and quantitative differences between the groups using the chi-square or Fisher’s exact tests for categorical variables and t-test for continuous variables. Results There were a total of 393 patients with a diagnosis of HCC. Among them, 128 (32.5%) were diagnosed with at least one psychiatric illness. Fewer patients with psychiatric illness (33.6%) underwent screening within six months before being diagnosed with HCC compared to those without psychiatric illness (49.8%) (p = 0.002). Patients with psychiatric illness (71.1%) were more likely to have been seen by a gastroenterologist or hepatologist before their diagnosis of HCC compared to those without psychiatric illness (55.1%) (p =0.002). Patients with psychiatric illness were more likely to be offered systemic chemotherapy or hospice (39.1%) compared to those without psychiatric illness (29.1%) (p =0.039). Discussion A significant number of HCC patients in our study group have an underlying psychiatric illness. Patients with psychiatric disorders are prone to high-risk behaviors, likely predisposing them to chronic liver disease and HCC. Patients with psychiatric disorders are less compliant with screening practices. Our findings suggest that psychiatric illnesses tend to be diagnosed with more extensive HCC, which is less amenable to curative treatment. Significant efforts need to be made to identify barriers to HCC screening in cirrhotic patients with psychiatric disorders.

Psychiatric disorders in patients with hepatocellular carcinoma: A large US cohort of commercially insured individuals

“…Prior studies suggested increased psychiatric burden among patients with HCC with more advanced tumour burden 39,40 . We were unable to determine tumour stage given the limitations of claims data; however, we were able to investigate the association between HCC treatment type and psychiatric diagnosis.…”

“…For incident cases of psychiatric disease, systemic therapy had a significantly higher odds of a new psychiatric diagnosis compared to other HCC treatment types. Hospice care was also associated with psychiatric disease highlighting the potential impact of significant liver dysfunction, limited functional status and poor overall prognosis on mental health 40 …”

“…38 Prior studies suggested increased psychiatric burden among patients with HCC with more advanced tumour burden. 39,40 We were unable to determine tumour stage given the limitations of claims data; however, we were able to investigate the association between HCC treatment type and psychiatric diagnosis. We found that patients undergoing liver transplantation had the highest risk of psychiatric conditions, followed by locoregional therapies, resection and ablation.…”

“…Hospice care was also associated with psychiatric disease highlighting the potential impact of significant liver dysfunction, limited functional status and poor overall prognosis on mental health. 40 Similar to the cancer care continuum, early identification of psychiatric conditions is only helpful if it increases downstream treatment. 44 Early referrals to mental health specialists and pharmacological treatments are effective ways to treat these conditions, improve quality of life, and lower the risk of cancer-related mortality for these patients.…”