Association between early job loss and prognosis among hepatocellular carcinoma survivors

Early job loss after curative treatment for hepatocellular carcinoma (HCC) is associated with significant socioeconomic and health challenges, potentially worsening patient outcomes.

To examine the impact of early job loss on all-cause mortality among HCC survivors following curative treatment.

We conducted a retrospective cohort study using Korean National Health Insurance Service data on 4578 HCC survivors (aged 35-54) with economic activity treated between 2009 and 2015. Primary and secondary outcomes were all-cause mortality and HCC recurrence, respectively. Early job loss was defined as a shift from insurer to dependent status. Adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated using multivariable Cox regression models, and subgroup analyses were performed. Causal mediation analysis assessed early HCC recurrence as a mediator between early job loss and all-cause mortality.

Among 4578 patients (median follow-up, 8.3 years), 1189 (26%) died including 989 (25%) in the job-maintained group and 200 (35%) in the early job loss group (P < .001). Early job loss was significantly associated with increased risk of all-cause mortality (adjusted HR 1.52 [95% CI 1.30-1.78]), but not with HCC recurrence (adjusted HR 1.07 [95% CI 0.91-1.25]). Subgroup analyses showed prominent association among middle-income level, non-liver cirrhosis, non-alcoholism, or surgical resection group. Early HCC recurrence plays a significant mediating role on the relationship between early job loss and all-cause mortality (mediated proportion 19%, 95% CI 5-31%).

Early job loss may increase risk of all-cause mortality among HCC survivors undergoing curative treatment.