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 Herman, Ihab Kamel, Jean-Francois Francois Geschwind, Ahmet Gurakar, Robert Anders, Andrew Cameron, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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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