V40: Effect of Hospital Safety Net Designation on Treatment Utilization and Associated Survival in Hepatocellular Carcinoma

Wednesday, March 2, 2022

6:10 PM – 6:13 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Gloria Y. Chang, MD

Clinical Research Fellow
UTSW
Dallas, Texas, United States

Disclosure: Disclosure information not submitted.

Participants should be aware of the following financial/non-financial relationships:

Gloria Y. Chang, MD: Disclosure information not submitted.

Introduction:

Healthcare disparities have been described for racial/ethnic minority and low socioeconomic status (SES) patients diagnosed with hepatocellular carcinoma (HCC). While the etiology of these disparities are multifactorial, comparing outcomes across healthcare delivery systems can identify biological and care delivery mechanisms contributing to these disparities. We compared patient and hospital characteristics, treatment use, and overall survival of those receiving care at safety net hospitals (SNHs) with non-SNHs.

Methods:

Patients diagnosed with HCC between 2004 and 2017 were identified in a combined dataset including the Texas and California Cancer Registries. Safety net designation was assigned according to each hospital’s disproportionate share hospital index extracted from CMS impact files. Those in the upper 25^th percentile were designated as SNHs. Hospital and patient-level factors, covariate-adjusted treatment use, and overall survival (OS) were compared.

Results:

Comprising 30% of hospitals, SNHs cared for 31% of the 48,421 HCC patients and disproportionately delivered care to racial/ethnic minorities and patients of low SES. Patients diagnosed at SNHs were less likely to receive treatment of any type (OR 0.73, 95% CI 0.70-0.76) and underwent less curative treatment: localized, 28 vs 35%; regional, 10 vs 15%; metastatic, 2% vs 3% (all, p< 0.001). Overall survival was worse for SNHs for localized (median, 19.0 vs 25.4 months) and regional (median, 5.0 vs 7.0 months) (p< 0.001), but there was no significant difference for metastatic stage. When adjusting for co-variates (not including treatment receipt), care at a SNH was associated with worse OS for localized and regional disease (Model 1). However, in fully adjusted models including treatment receipt (Model 2), care at a SNH was not independently associated with worse OS for any stage of disease. (Table 1)

Conclusions:

Patients at SNHs undergo less curative therapy and any HCC-directed treatment overall compared to those at non-SNHs. The lack of treatment receipt in SNHs is associated with worse overall outcome. Further studies are needed to determine the multi-level factors associated with failure to treat in SNHs.

Learning Objectives:

Describe key characteristics of patients with HCC presenting to safety net hospitals vs non-safety net hospitals
Recognize the difference in treatment use and pattern of delivery for HCC at safety net hospitals vs non-safety net hospitals
Identify factors that independently contribute to worse overall survival for patients with HCC at safety net hospitals