Elsevier

HPB

Volume 17, Issue 12, December 2015, Pages 1124-1129
HPB

Original Articles
Missing the obvious: psychosocial obstacles in Veterans with hepatocellular carcinoma

https://doi.org/10.1111/hpb.12508Get rights and content
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Abstract

Background

Socioeconomic disparities in patients with hepatocellular carcinoma (HCC) influence medical treatment. In addition to socioeconomic barriers, the Veteran population suffers from significant psychosocial obstacles. This study identifies the social challenges that Veterans face while undergoing treatment for HCC.

Methods

One hundred Veterans at the Palo Alto VA treated for HCC from 2009 to 2014 (50 consecutive patients who underwent a surgical procedure; 50 treated with intra‐arterial therapy) were retrospectively reviewed.

Results

Substance abuse history was identified in 96%, and half were unemployed. Most patients survived on a limited income [median $1340, interquartile range (IQR) 900–2125]; 36% on ≤ $1000/month, 37% between $1001–2000/month and 27% with >$2000/month. A history of homelessness was found in 30%, more common in those of the lowest income (57% of ≤$1K/month group, 23% of $1–2K/month group and 9% of >$2K/month group, P< 0.01). Psychiatric illness was present in 64/100 patients; among these the majority received ongoing psychiatric treatment. Transportation was provided to 23% of patients who would otherwise have been unable to attend medical appointments.

Conclusions

Psychiatric disease and substance abuse are highly prevalent among Veterans with HCC. Most patients survive on a very meager income. These profound socioeconomic and psychosocial problems must be recognized when providing care for HCC to this population to provide adequate treatment and surveillance.

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