Meta-analysis: Underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States

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Abstract

Background Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice. Aims To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics. Methods We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation. Results We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts. Conclusions Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.

Original languageEnglish (US)
Pages (from-to)703-712
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume38
Issue number7
DOIs
StatePublished - Oct 2013

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Meta-Analysis
Hepatocellular Carcinoma
Therapeutics
Demography
Social Class
Research Personnel
Databases
Confidence Intervals

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{04f04a167b9743dfb04ec91085626aae,
title = "Meta-analysis: Underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States",
abstract = "Background Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice. Aims To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics. Methods We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95{\%} confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation. Results We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8{\%} (95{\%} CI 52.2-53.4{\%}) and 21.8{\%} (95{\%} CI 21.4-22.1{\%}) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0{\%} (95{\%} CI 58.1-59.9{\%}). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts. Conclusions Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.",
author = "D. Tan and A. Yopp and Beg, {M. S.} and P. Gopal and Singal, {A. G.}",
year = "2013",
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doi = "10.1111/apt.12450",
language = "English (US)",
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T1 - Meta-analysis

T2 - Underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States

AU - Tan, D.

AU - Yopp, A.

AU - Beg, M. S.

AU - Gopal, P.

AU - Singal, A. G.

PY - 2013/10

Y1 - 2013/10

N2 - Background Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice. Aims To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics. Methods We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation. Results We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts. Conclusions Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.

AB - Background Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice. Aims To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics. Methods We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation. Results We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts. Conclusions Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.

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