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Published on: September 30, 2021
Missing the obvious: psychosocial obstacles in Veterans with hepatocellular carcinoma
Kimberly J Hwa1, Monica M Dua2, Sherry M Wren1,2
1Department of Surgery, Palo Alto Veterans Affairs, Palo Alto, CA, USA.
Insights
Hepatocellular carcinoma (HCC) treatment for Veterans is significantly impacted by substance abuse, unemployment, and low income. Addressing these socioeconomic and psychosocial challenges is crucial for effective patient care and surveillance.
Area of Science:
- Oncology
- Health Services Research
- Psychiatry
Background:
- Socioeconomic disparities significantly affect hepatocellular carcinoma (HCC) treatment outcomes.
- The Veteran population faces unique psychosocial obstacles in addition to socioeconomic barriers during HCC treatment.
- This study specifically investigates the social challenges encountered by Veterans undergoing HCC treatment.
Purpose of the Study:
- To identify and characterize the socioeconomic and psychosocial challenges faced by Veterans with hepatocellular carcinoma (HCC).
- To understand the prevalence of substance abuse, psychiatric illness, and financial instability in this patient group.
- To inform healthcare providers about the critical need to address these issues for improved HCC management in Veterans.
Main Methods:
- Retrospective review of 100 Veterans treated for HCC at the Palo Alto VA from 2009 to 2014.
- Analysis included patients who underwent surgical procedures (n=50) and those treated with intra-arterial therapy (n=50).
- Data collected included substance abuse history, employment status, income, homelessness, psychiatric diagnoses, and access to transportation.
Main Results:
- High prevalence of substance abuse history (96%) and unemployment (50%) among Veterans with HCC.
- Majority of patients lived on limited incomes (median $1340/month), with 36% earning $1000/month or less.
- Significant rates of homelessness (30%) and psychiatric illness (64%) were observed, with lower income correlating with higher homelessness rates.
Conclusions:
- Psychiatric disease and substance abuse are highly prevalent in Veterans with HCC, necessitating integrated care approaches.
- The majority of Veterans with HCC experience profound financial hardship, impacting their ability to access and adhere to treatment.
- Recognizing and addressing these socioeconomic and psychosocial factors is essential for optimizing treatment and surveillance for HCC in the Veteran population.
Background:
Socioeconomic disparities in patients with hepatocellular carcinoma (HCC) influence medical treatment. In addition to socioeconomic barriers, the Veteran population suffers from significant psychosocial obstacles. This study identifies the social challenges that Veterans face while undergoing treatment for HCC.
Methods:
One hundred Veterans at the Palo Alto VA treated for HCC from 2009 to 2014 (50 consecutive patients who underwent a surgical procedure; 50 treated with intra-arterial therapy) were retrospectively reviewed.
Results:
Substance abuse history was identified in 96%, and half were unemployed. Most patients survived on a limited income [median $1340, interquartile range (IQR) 900-2125]; 36% on ≤ $1000/month, 37% between $1001-2000/month and 27% with >$2000/month. A history of homelessness was found in 30%, more common in those of the lowest income (57% of ≤$1K/month group, 23% of $1-2K/month group and 9% of >$2K/month group, P < 0.01). Psychiatric illness was present in 64/100 patients; among these the majority received ongoing psychiatric treatment. Transportation was provided to 23% of patients who would otherwise have been unable to attend medical appointments.
Conclusions:
Psychiatric disease and substance abuse are highly prevalent among Veterans with HCC. Most patients survive on a very meager income. These profound socioeconomic and psychosocial problems must be recognized when providing care for HCC to this population to provide adequate treatment and surveillance.
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