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. 2021 Jul;10(13):4397-4404.
doi: 10.1002/cam4.3985. Epub 2021 May 31.

Adoption of single agent anticancer therapy for advanced hepatocellular carcinoma and impact of facility type, insurance status, and income on survival: Analysis of the national cancer database 2004-2014

Aman Opneja  1 , Gino Cioffi  2 , Asrar Alahmadi  1 , Nelroy Jones  1 , Tin-Yun Tang  1 , Nirav Patil  2 , David L Bajor  1 , Joel N Saltzman  1 , Amr Mohamed  1 , Eva Selfridge  1 , Ankit Mangla  1 , Jill Barnholtz-Sloan  2 , Richard T Lee  1   3
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Adoption of single agent anticancer therapy for advanced hepatocellular carcinoma and impact of facility type, insurance status, and income on survival: Analysis of the national cancer database 2004-2014

Aman Opneja et al. Cancer Med. 2021 Jul.

Abstract

Background: This study analyzes the pattern of use of single agent anticancer therapy (SAACT) in the treatment and survival of advanced hepatocellular carcinoma (aHCC) before and after sorafenib was FDA approved in 2007.

Methods: Adult patients diagnosed with HCC and treated with only ACT from 2004 - 2014 were identified in NCDB database. Patients were analyzed during three time frames: 2004-2006 (pre-sorafenib (PS)), 2007-2010 (early sorafenib (ES)) and 2011-2014 (late sorafenib (LS)). Cox proportional hazards models and Kaplan-Meier method were used for analyses.

Results: The NCDB contained 31,107 patients with HCC diagnosed from 2004-2014 and treated with ACT alone. Patients were generally men (78.0%), >50 years of age (92.5%). A significant increase in the rate of adaption of SAACT was observed over time: 6.2% PS, 15.2% ES, and 22.2% LS (p < 0.0001). During this later period, the highest proportion of SAACT is among academic and integrated network facilities (23.3%) as compared to community facilities (17.0%, p < 0.0001). The median overall survival of patients with aHCC treated only with SAACT improved significantly over time from 8.0 months (m) (95% CI: 7.4-8.8) to 10.7 m (10.4-11.2) to 15.6 m (15.2-16.0, p < 0.001). Multivariate analysis indicates worse outcomes for patients treated at community cancer programs (HR 1.28, (5% CI: 1.23-1.32), patients without insurance (HR 1.11, 1.06-1.16) and estimated household income of <$63,000 (HR 1.09, 1.05-1.13).

Conclusion: aHCC patients treated only with ACT have experienced an overall improvement in survival, but significant differences exist between facility type, insurance status, and income.

Keywords: chemotherapy; facility type; hepatocellular carcinoma; income; insurance; survival.

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Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Overall utilization of anticancer therapy for aHCC
FIGURE 2
FIGURE 2
Utilization of single agent anticancer therapy by facility type
FIGURE 3
FIGURE 3
Kaplan‐Meier survival curves of aHCC patients treated with anticancer therapy by time period
FIGURE 4
FIGURE 4
Kaplan‐Meier survival curves of aHCC patients treated with single agent anticancer therapy by time period
See this image and copyright information in PMC

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