Abstract
Background While we strive for progress in treatment and outcomes, it is imperative that disparities driven by socioeconomic factors are also recognized and addressed. We hypothesized that social determinants of health may predict delay in systemic therapy for metastatic hepatocellular carcinoma patients (HCC) and sought to examine the impact of Affordable Care Act (ACA). Methods National Cancer Database (NCDB) was queried for patients with metastatic hepatocellular carcinoma diagnosed from 2004-2015 and considered for first line systemic therapy within 6 months (180 days) of diagnosis. Time to initiation (TTI) was defined as time in days(d) from diagnosis of cancer to initiation of systemic therapy. Survival was measured in months(m) from the day of diagnosis. Multivariate analyses was performed using 2010 as cut-off between pre- and post-ACA for analysis. Results 630 patients meeting the eligibility criteria. Median TTI in the group was 57d. Only factor associated with delayed TTI (defined as forth quartile of TTI) in a multivariate logistic regression was non-Hispanic Black (NHB) race Odds Ratio OR 1.94(95%CI 1.0–3.3), p-value=0.052.
The OR showed improvement with implementation of ACA – OR3.6(95%CI 1.4-9.4),p- value 0.008 during pre-ACA vs. 1.3(0.5-3.1),p-value=0.6 post-ACA. There were non- significant trend towards higher mortality among NHB vs. NHW (HR 1.2, 95% CI 1.0- 1.6) and lower mortality for those insured vs. uninsured (HR 0.8, 95% CI 0.5-1.1.
Conclusion Race appears to impact timeliness to therapy in metastatic HCC patients and was positively impacted by ACA. Continued research to monitor disparities in care and identify underlying mechanisms to mitigate them are warranted.
Citation Format: Thejus Jayakrishnan, Veli Bakalov, Gene Finley, Dulabh Monga, Rodney Wegner. Influence of social determinants of health on timeliness to treatment for metastatic HCC and the impact of Affordable Care Act [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-206.