title: Patterns of consultation and treatment of patients with hepatocellular carcinoma presenting to a large academic medical center in the US.
abstract: BACKGROUND
  Management of hepatocellular carcinoma (HCC) often involves many subspecialist providers, as well as a broad range of treatment options. This study sought to evaluate referral and treatment patterns among patients with HCC at a large academic medical center.
  
  
  METHODS
  Data from our cancer registry between 2003-2011 were abstracted on 394 patients who were primarily diagnosed/treated for HCC at Johns Hopkins Hospital (JHH); data on patients who were diagnosed/treated with HCC elsewhere and who received secondary treatment at JHH (n = 391) were also abstracted for comparison purposes.
  
  
  RESULTS
  Among the main cohort, the most common specialties to be consulted were surgery (n = 225, 57.1%), gastroenterology (n = 225, 57.1%), and interventional radiologist (n = 206, 52.3%), while only 96 (24.4%) were referred to medical oncology. Factors associated with surgical consultation included younger age (odds ratio (OR) 3.35, 95% CI 1.62-6.92), tumor size <5 cm (OR 1.82, 1.09-3.02), and unilobar disease (OR 2.94, 1.31-6.59) (all P < 0.05). Patients initially diagnosed/treated elsewhere had larger tumors (4 vs. 6 cm), bilateral disease (19.2 vs. 26.8%), and were more likely to be seen by interventional radiology (all P < 0.05) CONCLUSIONS: Most patients were seen by surgeons, gastroenterologists, or interventional radiologists, with only a minority being seen by medical oncologists. Referral patterns depended on patient-level factors, as well as extent of disease.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Stacy
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: David
authors.initials: D
authors.lastname: Cosgrove
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Ihab
authors.initials: I
authors.lastname: Kamel
authors.forename: Jean-Francois H
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gurakar
authors.forename: Robert
authors.initials: R
authors.lastname: Anders
authors.forename: Andrew
authors.initials: A
authors.lastname: Cameron
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005762:Gastroenterology; D013502:General Surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008495:Medical Oncology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D015642:Radiology, Interventional; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents