Association Between Patient Experience Scores and Low Utilization of Hepatocellular Carcinoma Treatment in the United States: A SEER-CAHPS Analysis

•Data from the SEER-Medicare database showed that among 548 patients with HCC, only 39% received treatment specific to their cancer. •CAHPS survey findings showed 29%-78% of respondents reporting less-than-excellent patient-related experiences. •Presence of chronic liver disease, and easier access to specialist care was associated with higher HCC-specific treatment utilization. •HCC patients with absent or unrecognized chronic liver disease, and reduced access to specialist care may be less likely to receive treatment related to their HCC in the United States. Purpose To study HCC patient experiences contributing to treatment discrepancy in the U.S. Methods Using NCI’s SEER data, Medicare (2002-2015) beneficiaries with HCC who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey were included. Six CAHPS items (3 global scores: Global Care Rating [GCR], Primary Doctor Rating [PDR], Specialist Rating [SR]; 3 composite scores: Getting Needed Care [GNC], Getting Care Quickly [GCQ] and Doctor Communication [DC]) assessed patient experience. Covariates assessed between treated and non-treated groups included patient, disease, hospital, and CAHPS items. Results Among 548 patients with HCC, 211 (39%) received treatment, 337 (61%) did not. 42% (GCR), 29% (PDR), 30% (SR), 36% (GNC), 78% (GCQ), and 35% (DC) of patients reported less than excellent experiences on the respective CAHPS items. Chronic liver disease (CLD) was present in 52% and liver decompensation (LD) in 60%. A minority of the hospitals were NCI designated cancer centers (47%), transplant centers (27%), and referral centers (9%), On univariable analysis, patients with at least a high school degree (OR: 1.9), admittance to ≥ 400 bed hospital (OR: 2.7), CLD (OR: 3.0), or LD (OR: 1.7) were more likely to receive treatment, while older patients (≥ 75) (OR: 0.5) less likely. On multivariable, patients with CLD (OR: 6.8) and an excellent experience in GNC with a specialist (OR: 10.6) were more likely to receive treatment. Conclusion HCC treatment discrepancy may be associated with patient-related factors like lack of specialist care (GNC), and disease-related factors like absence of underlying CLD. To study HCC patient experiences contributing to treatment discrepancy in the U.S. Using NCI’s SEER data, Medicare (2002-2015) beneficiaries with HCC who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey were included. Six CAHPS items (3 global scores: Global Care Rating [GCR], Primary Doctor Rating [PDR], Specialist Rating [SR]; 3 composite scores: Getting Needed Care [GNC], Getting Care Quickly [GCQ] and Doctor Communication [DC]) assessed patient experience. Covariates assessed between treated and non-treated groups included patient, disease, hospital, and CAHPS items. Among 548 patients with HCC, 211 (39%) received treatment, 337 (61%) did not. 42% (GCR), 29% (PDR), 30% (SR), 36% (GNC), 78% (GCQ), and 35% (DC) of patients reported less than excellent experiences on the respective CAHPS items. Chronic liver disease (CLD) was present in 52% and liver decompensation (LD) in 60%. A minority of the hospitals were NCI designated cancer centers (47%), transplant centers (27%), and referral centers (9%), On univariable analysis, patients with at least a high school degree (OR: 1.9), admittance to ≥ 400 bed hospital (OR: 2.7), CLD (OR: 3.0), or LD (OR: 1.7) were more likely to receive treatment, while older patients (≥ 75) (OR: 0.5) less likely. On multivariable, patients with CLD (OR: 6.8) and an excellent experience in GNC with a specialist (OR: 10.6) were more likely to receive treatment. HCC treatment discrepancy may be associated with patient-related factors like lack of specialist care (GNC), and disease-related factors like absence of underlying CLD.