ArticleAnnals of surgery2016
Differences in Physician Referral Drive Disparities in Surgical Intervention for Hepatocellular Carcinoma: A Retrospective Cohort Study.
Article in Annals of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Racial and Ethnic Disparities in Hepatocellular Carcinoma Treatment Receipt in the United States: A Systematic Review and Meta-Analysis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2024Pooled it
- Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map.Journal of the American College of Surgeons · 2019Pooled it
- Social and Surgical Drivers of Survival in Colorectal Liver Metastases: An NCBD Analysis.Journal of surgical oncology · 2026Article
- Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia.Cancer research communications · 2024Article
- Treatment Disparities Partially Mediate Socioeconomic- and Race/Ethnicity-Based Survival Disparities in Stage I-II Hepatocellular Carcinoma.Annals of surgical oncology · 2023Article
- Determinants of the access to remote specialised services provided by national sarcoma reference centres.BMC cancer · 2021Article
- The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance.Cancer medicine · 2019Article
- Socioeconomic Inequalities in the Utilization of Colorectal Stents for the Treatment of Malignant Bowel Obstruction.Digestive diseases and sciences · 2016Article
- Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act.American journal of surgery · 2016Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveTo determine whether sociodemographic and geographic factors are associated with referral for surgery and receipt of recommended surgical intervention.
backgroundSurgical interventions confer survival advantages compared with palliative therapies for hepatocellular carcinoma (HCC), but disparities exist in use of surgical intervention. Few have investigated referral for surgery as a potential barrier to surgical intervention, and little is known about the effects of patient geographic factors, including proximity to surgical centers.
methodsData were abstracted from the Pennsylvania Cancer Registry for patients with a diagnosis of HCC from 2006 to 2011. Using hospital procedure volume data from the Pennsylvania Health Care Cost Containment Council, we calculated proximity to a surgical center. We used multivariable logistic regression to determine whether geographic, racial, socioeconomic, and clinical factors were associated with referral for surgery and receipt of a recommended surgical intervention.
resultsOf 3576 patients with HCC, 41.0% were referred for surgery. Patients who lived closer to a surgical center were less likely to be referred for surgery (adjusted odds ratio = 0.79; 95% confidence interval, 0.68-0.92). Surgical referral was less likely among older, male patients with Medicaid insurance and advanced tumor stage at diagnosis. Of those referred, 1276 (87.0%) underwent surgical intervention. Proximity to a surgical center was not associated with receipt of surgical intervention (P = 0.27). Patients with distant tumor stage at diagnosis were less likely to receive recommended surgical intervention (adjusted odds ratio = 0.27; 95% confidence interval, 0.15-0.50).
conclusionsGeographic and sociodemographic disparities in referral for surgery may be major barriers to surgical intervention for patients with HCC.
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