Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only gastroenterology specialists, and not liver disease specialists (hepatologists) were less likely to receive curative therapy, leading to lower survival rates. Finally, the authors built on previous research linking presentation of the case to a multidisciplinary tumor board with increased survival rates. They noted that patients who did not have access to a hepatologist were less likely to receive treatment at an academically affiliated VA center, and less likely to have their case presented to a tumor board. Lastly, geography was associated with survival rates, with patients living in areas lacking a VA center experiencing lower survival rates. Incorporating these factors into quality measures, designation of outcome-based HCC centers of excellence by the VA, and use of telehealth in areas lacking a VA may allow for future improvements in quality of HCC care.