M. Hargis1, D. Danos2,3, H. R. Malinosky1, A. G. Chapple2,3, M. Al Efishat4, J. Lyons4, J. C. Watson1,3, M. Maluccio1,3, V. N. Nfonsam1,3, O. Moaven1,2,3 1Louisiana State University Health Sciences Center, Department Of Surgery, Division Of Surgical Oncology, New Orleans, LA, USA 2Louisiana State University Health Sciences Center, Department Of Interdisciplinary Oncology, New Orleans, LA, USA 3LSU-LCMC Cancer Center, New Orleans, LA, USA 4Louisiana State University Health Sciences Center, Department Of Surgery, Baton Rouge, LA, USA
Introduction:
In the United States, liver cancer incidence and mortality have been shown to differ by race, ethnicity, and geographical region. Louisiana rates in the 3rd quartile for liver cancer incidence but is among the states with the highest liver cancer mortality rates. This study aims to analyze disparities in the multimodal treatment of liver cancer and its impact on the outcomes of liver cancer patients in Louisiana.
Methods:
Cases of primary non-metastatic liver cancer in Louisiana from 2010-2020 were obtained from the Louisiana Tumor Registry. Nonsurgical therapy was defined as receiving radiation, chemotherapy, or immunotherapy using the North American Association of Central Cancer Registries treatment summary variables. Generalized linear mixed models were used to model the receipt of non-surgical therapy, receipt of any therapy, and time to the first course of treatment. Overall survival was analyzed with Cox proportional hazards models.
Results:
A total of 2,948 patients met the inclusion criteria. Of these patients, 23.7% received surgical therapy, 56% received nonsurgical therapy, and 30.5% received no therapy at all. Multivariable (MV) models identified older age, no domestic partner, no insurance, Medicaid/Medicare, rural residence, high poverty, and resection as risk factors for not receiving non-surgical therapy. Similarly, patients with increased odds of pursuing no treatment for their liver cancer include those 70 and older (OR:1.65; 95%CI:1.27-2.14), no domestic partner (OR:1.41; 95%CI:1.18-1.69), uninsured (OR:4.13; 95%CI:2.79-6.22), high poverty (OR:1.24; 95%CI:1.03-1.49), rural residence (OR:1.36; 95%CI:1.07-1.74) and locally advanced tumors (OR:1.76; 95%CI:1.49-2.09).
Of patients receiving treatment, non-surgical therapy accounted for 53.7% of patients’ first course of treatment versus 15.1% with surgery. The median time to treatment was longer for patients with non-surgical therapy as the first treatment compared to surgery [41 (interquartile range IQR, 22-72 days) vs. 33 days (IQR, 0-68 days), p<.0001]. In the MV analysis, other risk factors for increased time to first treatment include age 60-69, no domestic partner, and rural residence. The addition of non-surgical therapy was associated with improved overall survival for patients who did not undergo any surgical interventions (HR:0.42; 95%CI:0.38-0.46), p<.0001).
Conclusion:
Available therapeutic modalities are significantly underutilized in LA. A considerable number of patients with nonmetastatic primary liver tumors receive no treatment and have significantly worse outcomes. Older age, no domestic partner, no insurance, rural residence, and high poverty are independent risk factors for not receiving any treatment for nonmetastatic primary liver cancer. Identifying patients with these risk factors in tertiary referral centers with plans to allocate resources accordingly is an important step in reversing inequities in access to care and improving outcomes.