Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Sylvie Stacy, Omar Hyder, David Cosgrove, Joseph M. Herman, Ihab Kamel, Jean Francois H. Geschwind, Ahmet Gurakar, Robert Anders, Andrew Cameron, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Management of hepatocellular carcinoma (HCC) often involves many subspecialist providers, as well as a broad range of treatment options. This study sought to evaluate referral and treatment patterns among patients with HCC at a large academic medical center. Methods: Data from our cancer registry between 2003-2011 were abstracted on 394 patients who were primarily diagnosed/treated for HCC at Johns Hopkins Hospital (JHH); data on patients who were diagnosed/treated with HCC elsewhere and who received secondary treatment at JHH (n = 391) were also abstracted for comparison purposes. Results: Among the main cohort, the most common specialties to be consulted were surgery (n = 225, 57.1 %), gastroenterology (n = 225, 57.1 %), and interventional radiologist (n = 206, 52.3 %), while only 96 (24.4 %) were referred to medical oncology. Factors associated with surgical consultation included younger age (odds ratio (OR) 3.35, 95 % CI 1.62-6.92), tumor size <5 cm (OR 1.82, 1.09-3.02), and unilobar disease (OR 2.94, 1.31-6.59) (all P < 0.05). Patients initially diagnosed/treated elsewhere had larger tumors (4 vs. 6 cm), bilateral disease (19.2 vs. 26.8 %), and were more likely to be seen by interventional radiology (all P < 0.05) Conclusions: Most patients were seen by surgeons, gastroenterologists, or interventional radiologists, with only a minority being seen by medical oncologists. Referral patterns depended on patient-level factors, as well as extent of disease.

Original languageEnglish (US)
Pages (from-to)1600-1608
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number9
DOIs
StatePublished - Sep 2013

Keywords

  • Carcinoma
  • Consultation
  • Hepatocellular
  • Referral patterns

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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