Cirrhosis Patients Skimp on Cancer Screening Because of Cost

Kerry Dooley Young

November 13, 2019

Concern about cost often means that patients with cirrhosis, who are at high risk for liver cancer, delay seeking medical care, including recommended screening, results from a new survey show.

"This is one of the reasons this cancer is often found at late stages and continues to be deadly" for many patients, said Amit Singal, MD, from the UT Southwestern Medical Center in Dallas.

Previous research has shown that only a minority of patients with cirrhosis receive the recommended hepatocellular carcinoma screening, he explained at the Liver Meeting 2019 in Boston.

To quantify the challenges faced by patients at risk for hepatocellular carcinoma due to cirrhosis, Singal and his colleagues asked 2871 patients with cirrhosis who were being followed at three sites in Texas to complete a telephone survey.

Of the 1021 respondents, 9.5% reported that they had delayed care because of the financial burden, including the cost of cancer screening; 11.8% reported that they needed to borrow money or go into debt to pay for care; 24.4% said they were unable to afford copays or deductibles; and 42.8% expressed worry about being able to pay their medical bills.

The survey results might have been different if this research had been done in one of the states that expanded its Medicaid program in recent years — Texas is one of 14 states that have not accepted the financial assistance created by the Affordable Care Act to raise income thresholds for Medicaid — but even patients with private insurance had financial concerns, Singal pointed out.

Most survey respondents had some form of medical coverage, but that did not mean they could always afford to pay for ultrasound tests, arrange transportation, or take time off work to get screening, he reported.

"This adds to other data that really highlight the need for long-term policy reform that can expand coverage benefits and limit out-of-pocket spending to decrease the financial burden on patients," Singal told Medscape Medical News.

A delay in the evaluation and treatment affects survival.

These results highlight the need to make follow-up care more affordable for patients, said Jorge Marrero, MD, also from the UT Southwestern Medical Center but not involved in the survey.

As a specialist who treats hepatocellular carcinoma, Marrero said he too often sees patients whose disease has progressed because they missed out on earlier screening.

"A delay in evaluation and treatment affects survival," Marrero told Medscape Medical News. "Any delay in surveillance will lead to a tumor burden that is larger and then lead to a more difficult intervention."

Barriers to care faced by people with serious liver disease were discussed during another session at the meeting by Carrie Wong, MD, from the University of California, Los Angeles.

She and her colleagues used results from the Centers for Disease Control and Prevention's National Health Interview Survey (NHIS) to analyze self-reported obstacles to care.

National estimates derived from their sample of 85,645 individuals represented more than 130 million people: approximately 1.6 million with chronic liver disease, 3.8 million with chronic obstructive pulmonary disease (COPD), 7.9 million with chronic heart disease, and 117 million with no chronic disease.

Wong's team examined reports of obstacles to routine care, including financial concerns and difficulties securing providers or appointments.

A barrier to care was experienced by 35.0% of the patients with chronic liver disease, 34.1% of those with COPD, 25.9% of those with chronic heart disease, and 17.2% with no chronic disease.

This translates into an estimated population of more than half a million people with chronic liver disease who face obstacles to routine medical care, and has implications for preventive care and hospitalizations, Wong told Medscape Medical News.

The Liver Meeting 2019: American Association for the Study of Liver Diseases (AASLD): Abstract 201, presented November 10, 2019; abstract 125, presented November 11, 2019.

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