Multispecialist Care and Mortality in Hepatocellular Carcinoma.
OBJECTIVE
Multidisciplinary physician care has increased for many cancers yet little evidence exists for hepatocellular carcinoma (HCC). The purpose of this study was to explore the association between multispecialist care and mortality in HCC.


METHODS
Treated patients with an HCC primary diagnosis from 2000 to 2007 were studied using Surveillance, Epidemiology, and End Results-Medicare data. A surrogate variable for multidisciplinary care was defined-multispecialist care-as the number of disciplines among surgeons, radiology oncologist, intervention radiologist, hematologist/medical oncologist, gastroenterologist, and generalist in the pretreatment period. Multivariate survival analysis was conducted and adjusted for selection and survival bias.


RESULTS
Of 3588 treated HCC patients, 1434 (40%) saw 1, 1343 (37%) saw 2, and 811 (23%) saw 3 or more specialists. Patients with multispecialist care received treatment that differed from patients who saw a single specialist. In propensity score-adjusted survival analysis, patients who saw 3 or more specialist types were associated with 10% (P=0.04) reduced mortality, compared with those who saw 1 specialist. When stratified by treatment received, patients on chemotherapy who saw 3 or more specialist types were associated with 28% (P=0.002) reduced mortality, compared with those who saw 1 specialist.


CONCLUSIONS
Multispecialist care for treated HCC patients was associated with reduced mortality, particularly among chemotherapy recipients. While adjusting for selection and survival bias, our study is limited in capturing a causal relationship between coordinated multidisciplinary care and mortality. Our findings may provide support for the development of coordinated care delivery models but should be confirmed through more rigorous examination in future studies.
*Department of Pharmaceutical Health Services Research †Division of Surgical Oncology, University of Maryland School of Medicine, Baltimore, MD ‡Department of Health Economics and Outcomes Research, Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ.
Viktor V
VV
Chirikov
C Daniel
CD
Mullins
Nader
N
Hanna
Ian M
IM
Breunig
Brian
B
Seal
Fadia T
FT
Shaya
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D058006:General Practice / Q000706:statistics & numerical data*; D013502:General Surgery / Q000706:statistics & numerical data*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D015642:Radiology, Interventional / Q000706:statistics & numerical data*; D011878:Radiotherapy; D018426:SEER Program; D016019:Survival Analysis; D014481:United States
D000970:Antineoplastic Agents