Psychosocial Barriers and Their Impact on Hepatocellular Carcinoma Care in US Veterans: Tumor Board Model of Care.

Parul D Agarwal, Beth A Haftoglou, Timothy J Ziemlewicz, Michael R Lucey, Adnan Said
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Abstract

Background: Psychosocial barriers, including low socioeconomic status, homelessness, alcohol and substance use disorders, and psychiatric disorders are prevalent in US veterans. Our study aims to identify the prevalence of psychosocial barriers in veterans diagnosed with hepatocellular carcinoma (HCC), and their impact on receipt of cancer care.

Methods: A retrospective cohort study was performed of all veterans diagnosed with HCC at the William S. Middleton Memorial Veterans' Hospital in Madison, Wisconsin, whose tumor care was coordinated through a multidisciplinary tumor board. Outcomes included receipt of any HCC-specific therapy and overall survival.

Results: From January 1, 2007, through December 31, 2016, 149 veterans were diagnosed with HCC. Substance use disorders were reported in 124 (83%) patients, psychiatric illness was documented in 55 (37%) patients, 23 (15%) patients had incomes below the poverty threshold, and 7 (5%) were experiencing homelessness. The mean (SD) distance traveled for care was 207.1 (277.9) km; travel and lodging assistance were accessed by 50 (34%) and 33 (22%) veterans, respectively. Seventy-one patients (48%) had HCC exceeding T2 stage at diagnosis. Curative treatment was offered to 78 (52%) patients, with 127 (85%) receiving any HCC-specific care. Median survival from diagnosis was 727 days (95% CI, 488-966).

Conclusions: Psychosocial barriers were common in our veteran cohort. Individualizing care, and coordination of travel and lodging, assisted in enabling high rates of receipt of HCC-specific therapy and improving patient survival.

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心理社会障碍及其对美国退伍军人肝细胞癌护理的影响:肿瘤委员会护理模式。
背景:社会心理障碍,包括低社会经济地位、无家可归、酒精和物质使用障碍以及精神障碍在美国退伍军人中普遍存在。我们的研究旨在确定被诊断为肝细胞癌(HCC)的退伍军人的心理社会障碍的患病率,以及它们对接受癌症治疗的影响。方法:回顾性队列研究在威斯康辛州麦迪逊William S. Middleton Memorial veterans ' Hospital诊断为HCC的所有退伍军人,他们的肿瘤治疗是通过一个多学科肿瘤委员会协调的。结果包括接受任何hcc特异性治疗和总生存期。结果:从2007年1月1日到2016年12月31日,149名退伍军人被诊断为HCC。124名(83%)患者报告有物质使用障碍,55名(37%)患者记录有精神疾病,23名(15%)患者收入低于贫困线,7名(5%)患者无家可归。平均(SD)路程为207.1 (277.9)km;分别有50名(34%)和33名(22%)退伍军人获得了旅行和住宿援助。71例(48%)HCC诊断时超过T2期。78例(52%)患者接受了根治性治疗,127例(85%)患者接受了hcc特异性治疗。诊断后的中位生存期为727天(95% CI, 488-966)。结论:心理社会障碍在我们的退伍军人队列中很常见。个性化护理以及旅行和住宿的协调有助于提高hcc特异性治疗的接受率,并改善患者的生存率。
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