CHICAGO — Only 13% of U.S. patients diagnosed with hepatocellular carcinoma receive potentially curative therapy, Hashem B. El-Serag, M.D., said at the annual Digestive Disease Week.
Moreover, only one-third of those with single lesions get potentially curative therapy, said Dr. El-Serag of Baylor College of Medicine, Houston.
In other countries, potentially curative therapy appears to be used at much higher rates. Such treatment was provided for 40% of all hepatocellular carcinoma patients in a series from Barcelona and 30% of all patients aged over 75 years in Italy.
“There is significant underutilization of potentially curative therapy, even among those with favorable clinical features,” said Dr. El-Serag, who, with his colleagues, examined data for a nationwide cancer registry that is now linked to Medicare data. “The reasons for this observation need to be examined and corrected.”
Dr. El-Serag's study included data from 2,963 patients with hepatocellular carcinoma diagnosed between 1992 and 1999. The patients were entered into any 1 of 11 different regional cancer registries.
In addition to the 13% of patients who received potentially curative therapy, 4% received transarterial chemoablation and 35% received systemic chemotherapy or radiotherapy. The other 48% of the patients received no treatment at all.
The study found that age and ethnicity affected which patients received potentially curative therapy. Among those aged 65–74 years, the rate of the use of potentially curative therapy was 17%, and among racial groups, Asian people had the highest rate of potentially curative therapy—24%—apparently because they had more single and small tumors.
But neither of those characteristics had as strong an influence on rate as did the region where the cancer was diagnosed, Dr. El-Serag said, although he did not identify which regions had the highest or lowest rates.
The rates of attempted therapy did increase over time in the study, but this improvement was not dramatic, he added. For example, between 1992 and 1995, 53% of patients received no treatment. But the rate fell to 43% between 1996 and 1999.
Many physicians have too dismal a view of the prognosis of hepatocellular carcinoma, and that perception does not appear to have changed much between 1999 and the present, Dr. El-Serag said. Specifically, the majority of physicians still do not know that liver transplantation is an option for liver cancer, he added.