Modality-Specific and Multilevel Barriers to Curative Treatment for Early-Stage Hepatocellular Carcinoma

Area of Science:

• Hepatology
• Oncology
• Health Services Research

Background:

• Early-stage hepatocellular carcinoma (HCC) patients are candidates for curative treatments.
• These potentially curative therapies are significantly underused in clinical practice.
• Identifying barriers to treatment is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate factors associated with the underuse of curative treatments for early-stage HCC.
• To identify specific barriers hindering access to potentially curative therapies.
• To inform the development of multilevel interventions to improve treatment rates.

Main Methods:

• Retrospective cohort study of patients with treatment-naïve, early-stage HCC (within Milan criteria).
• Data collected from January 2010 to July 2021 across two US health systems.
• Univariable and multivariable logistic regression used to analyze factors associated with curative treatment receipt.

Main Results:

• Of 629 eligible patients, 63.0% received curative treatment.
• Tertiary care center evaluation was linked to higher odds of treatment (OR 2.95).
• Medicaid, county subsidy programs, lack of insurance, multifocal disease, larger tumor size, and worse liver function were associated with lower odds of treatment.

Conclusions:

• Underuse of curative HCC treatment is influenced by tumor-specific, clinical, and system-level factors.
• Barriers include insurance status, disease characteristics, and liver function.
• Multilevel interventions are necessary to address these barriers and improve access to care.