Wei Zhang, MD, PhD: Recognizing Disparities in Hepatocellular Carcinoma Diagnosis, Care

A large US-based registry analysis identified significant disparities in hepatocellular carcinoma (HCC) survival by sex, race and ethnicity, income, and geographical regions, according to a presentation at Digestive Disease Week (DDW) 2024.¹

These disparities in mortality among ethnic minorities were compounded by sociodemographic factors, particularly for African Americans with HCC, suggesting the importance of addressing the root causes of complex social and structural barriers to HCC care.

In an interview with HCPLive, Wei Zhang, MD, PhD, a transplant hepatologist at Massachusetts General Hospital and assistant professor at Harvard Medical School, indicated the most important long-term outcome for HCC is survival. He noted that patients who are unable to be diagnosed early are also unable to be treated early, and this leads to a rapid decrease in survival rates.

“Survival is affected by a late diagnosis because there may be fewer options to treat the liver cancer and this affects the quality of life,” Zhang told HCPLive. “Those patients with advanced disease need to receive more treatments and more aggressive treatments, and that could significantly affect how they function in daily life.”

The third-leading cause of cancer-related mortality globally, disparities in access to HCC care, and lack of timely diagnosis can lead to significantly worse overall outcomes, particularly among ethnic minorities and vulnerable populations.

For this analysis, Zhang and colleagues identified adults with HCC from 2000 to 2020 data in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) cancer registry database. They obtained information on geography, annual median household income, and overall survival rates.

Among 112,389 adults with HCC, the overall 5-year survival rate was 23.0%. More than half (66.2%) of patients were aged ≥60 years, 12.0% were African American, 20.5% were Hispanic, and 49.8% were non-Hispanic White.

Survival rates were significantly lower among males versus females (22.1% vs. 25.9%; P <.05). In comparison to non-Hispanic White patients, HCC mortality was higher among African Americans (adjusted hazard ratio [aHR], 1.07; 95% CI, 1.04 - 1.10; P <.05).

Compared with large metropolitan (>1 million residents) regions, individuals with HCC in medium (250,000 to 1 million residents), small (<250,000 residents), and rural regions experienced significantly higher mortality (P <.05 for all). Further, compared with the highest earners (≥$70,000), significantly higher mortality was observed across the lowest 3 income quartiles (<40,000 to $69,999; P <.05 for all).

In particular, lower household income worsened racial and ethnic disparities in HCC—African American patients in quartile 3 ($55,000 to $69,999) experienced 18% higher mortality, while those in the lowest quartile (<$40,000) had nearly 40% higher mortality (P <.05 for all).

“Maybe we should pay more attention to this population with socioeconomic issues, particularly in patients who have low income, or if they have low health literacy and low education,” Zhang told HCPLive. “We could educate this population with hepatitis B or C, so they are aware that they need to be started to be screened at an early stage, instead of not having any regular screening tests that could delay the diagnosis.”

Disclosures: Zhang reports no relevant disclosures

References

1. _{Thiemann A, Patel S, Zhang W, Cheung R, Wong R. Disparities in Hepatocellular Carcinoma Survival and Mortality: A Large National Cancer Registry Analysis in the United States. Poster presented at Digestive Disease Week 2024, May 18 - 21, 2024.}
2. _{Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660}