Racial, Ethnic, and Socioeconomic Disparities in Treatment Delay Among Patients With Hepatocellular Carcinoma in the United States

Wagle, Nikita Sandeep; Park, Sulki; Washburn, David J.; Ohsfeldt, Robert L.; Rich, Nicole E.; Singal, Amit G.; Kum, Hye‐Chung

doi:10.1016/j.cgh.2022.07.031

Cited by 19 publications

(33 citation statements)

References 40 publications

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“…Less described is how it impacted care delivery for cancer patients, who face unique challenges in accessing care. Prior to the COVID‐19 pandemic, prevalence of treatment delays in three common cancers, bladder, hepatocellular, and breast, in the US since the early 2000s have ranged from reports of 11%–15%, in stark contrast to the 32.1% of patients reporting delay in cancer care due to the COVID‐19 pandemic demonstrated in this study 16–18 . A systematic review of global delays and disruptions in cancer care due to COVID‐19 demonstrated that physician or system‐related factors were the most frequently identified causes of disruptions in care.…”

Section: Discussionmentioning

confidence: 69%

“…Prior to the COVID‐19 pandemic, prevalence of treatment delays in three common cancers, bladder, hepatocellular, and breast, in the US since the early 2000s have ranged from reports of 11%–15%, in stark contrast to the 32.1% of patients reporting delay in cancer care due to the COVID‐19 pandemic demonstrated in this study. 16 , 17 , 18 A systematic review of global delays and disruptions in cancer care due to COVID‐19 demonstrated that physician or system‐related factors were the most frequently identified causes of disruptions in care. This was mainly due to reduction in service availability through personnel or other supply chain issues, and predominantly affected availability of medical visits, surgeries, procedures, radiotherapy and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to the COVID-19 pandemic, prevalence of treatment delays in three common cancers, bladder, hepatocellular, and breast, in the US since the early 2000s have ranged from reports of 11%-15%, in stark contrast to the 32.1% of patients reporting delay in cancer care due to the COVID-19 pandemic demonstrated in this study. [16][17][18] A systematic review of global delays and disruptions in cancer care due to COVID-19 demonstrated that physician F I G U R E 2 Patient-reported disruptions in cancer care by cancer type for patients reporting history of one cancer. Patients reporting history of only one cancer were analyzed as this was the most accurate way of determining for which type of cancer patients were reportedly requiring treatment.…”

Section: Discussionmentioning

confidence: 99%

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Patient‐reported disruptions to cancer care during the COVID‐19 pandemic: A national cross‐sectional study

et al. 2022

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Background The aim of this study is to evaluate the extent and associations with patient‐reported disruptions to cancer treatment and cancer‐related care during the COVID‐19 pandemic utilizing nationally representative data. Methods This analysis uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross‐sectional survey of US adults. Adults (age >18) who reported requiring current cancer treatment or other cancer‐related medical care in the second half of 2020 were included. Estimated proportions of patients with self‐reported changes, delays, or cancelations to cancer treatment or other cancer care due to the COVID‐19 pandemic were calculated using sampling weights and associations with sociodemographic and other health‐related variables were analyzed. Results In total, 574 (sample‐weighted estimate of 2,867,326) adults reported requiring cancer treatment and/or other cancer care since the start of the COVID‐19 pandemic. An estimated 32.1% reported any change, delay, or cancelation. On sample‐weighted univariable analysis, patients who were younger, female, had one or fewer comorbidities, and uninsured were significantly more likely to report disruptions. On sample‐weighted, multivariable analysis, patients who were younger and female remained significant predictors. Nearly 90% of patients included in the study reported virtual appointment use. Patients reporting disruptions were also significantly more likely to report feelings of anxiety. Conclusions An estimated 1/3 of patients experienced disruptions to cancer care due to the COVID‐19 pandemic. Patients experiencing disruptions in care were more likely to be female or younger which may reflect risk stratification strategies in the early stages of the pandemic, and also had higher rates of anxiety. The longitudinal impact of these disruptions on outcomes merits further study.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient‐reported disruptions to cancer care during the COVID‐19 pandemic: A national cross‐sectional study

et al. 2022

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“…Our results are concordant with those of prior studies that have demonstrated racial and socioeconomic disparities in the time to treatment of HCC, where Black and low-income patients with HCC were more likely to experience treatment delays. 35 In addition, Black, Hispanic, and underinsured/uninsured patients were less likely to undergo curative therapy for HCC. 36 , 37 Our data suggest that the pandemic further exacerbated these inequalities.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study

et al. 2023

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Background The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. Methods The National Cancer Database was queried for patients diagnosed with clinical stages I–IV HCC (2017–2020). Patients were categorized based on their year of diagnosis as “Pre-COVID” (2017–2019) and “COVID” (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). Results In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022–1.093; p = 0.0013), 1.045 (95% CI: 1.010–1.081; p = 0.0104), and 1.088 (95% CI: 1.053–1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. Conclusions For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI.

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“…For example, while rates of mammographic screening are largely similar between Black and White women in the USA, the quality of the screening process, including lower access to digital mammography and dedicated breast imaging specialists, may lead to later-stage diagnosis in minority women [ 4 ]. Patients living in high-poverty neighborhoods were significantly more likely to experience treatment delays for HCC than those living in low-poverty neighborhoods [ 5 ]. Finally, providers of hospice care demonstrate a lack of awareness regarding the different needs of LGBTQ patients, which may negatively affect their end-of-life experience [ 6 ].…”

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confidence: 99%

Effect of Differences in Access to Screening, Healthcare, and Treatment on Cancer Disparities

Ellsworth

2022

IJERPH

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Racial, Ethnic, and Socioeconomic Disparities in Treatment Delay Among Patients With Hepatocellular Carcinoma in the United States

Cited by 19 publications

References 40 publications

Patient‐reported disruptions to cancer care during the COVID‐19 pandemic: A national cross‐sectional study

Patient‐reported disruptions to cancer care during the COVID‐19 pandemic: A national cross‐sectional study

The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study

Effect of Differences in Access to Screening, Healthcare, and Treatment on Cancer Disparities

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