Addressing Ongoing Disparities in Liver Cancer Care: Dr Amit Singal

Amit Singal, MD, medical director of the Liver Tumor Program and chief of hepatology at UT Southwestern Medical Center, discusses his research on disparities in hepatocellular carcinoma (HCC) care and outcomes in the US. In a previous interview with The American Journal of Managed Care^®, Singal spoke to underuse of the latest HCC therapies in clinical practice and the importance of multidisciplinary care for HCC to ensure optimal treatment.

This transcript has been lightly edited.

Transcript

You co-authored a review highlighting racial and ethnic disparities in HCC treatment in the US. What were the main findings, and how might these disparities be addressed?

So this goes back to the point that we just discussed in terms of the underuse of screening, as well as the underuse of treatment. And unfortunately, that underuse is not evenly distributed across society.

We know that there are some subgroups which have higher proportions of underuse, and so the study that you're referencing discusses the underuse of therapy in different segments of society, looking at race and ethnicity specifically. We found, using a systematic review of the literature, that Black patients compared to White patients had lower odds of any treatment, as well as lower odds of curative therapy, and Hispanic patients had lower odds of curative therapy compared to non-Hispanic Whites—really showing that these segments of the population, unfortunately, are disproportionately impacted by treatment underuse. This partly explains why HCC-related mortality is higher in these subgroups compared to non-Hispanic Whites. Unfortunately, we see similar findings when we take a look at underuse of HCC screening, amongst other factors along that treatment cascade.

I have to say that it's easier to find these disparities and report these disparities, and it's been a taller task when you think of interventions that can address disparities—although that's clearly what we need to do as the next step. When we think through why these disparities exist, these disparities exist for multiple different reasons. This can be at the patient level, provider level, system, and community level. So when we think through this, we really need to think through multilevel interventions that will make patients more comfortable, more engaged with health care. We need to address other issues like transportation, financial barriers that exist in our current health care system. We need to address very difficult issues of provider implicit bias. We need to address some of the community-level barriers, like the ability to go out and feel safe in your neighborhood, the ability to have access to healthy foods and health care locally, so you don't have to drive 50 miles to a multidisciplinary setting to receive good HCC care.

Clearly, these interventions, once again are easier for me to list out and describe here. But we really need to work together as a community and work with these communities to implement these interventions to improve outcomes in the future.

Reference

Schoenberger H, Rich NE, Jones P, et al. Racial and ethnic disparities in barriers to care in patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2023;21(4):1094-1096.e2. doi:10.1016/j.cgh.2021.12.027