Martin
Data from the VA health care system shows promising results.
Use of interventional radiology (IR) services within the Veteran's Administration (VA) health care system has grown, and there has been a corresponding increase in the median overall survival of patients with hepatocellular carcinoma (HCC), according to the authors of research presented Monday.
"IR procedures in combination with multidisciplinary patient care result in a significantly improved overall survival," noted Lynne Martin, MD, a radiology resident at Stanford University in Palo Alto, CA.
"Our study can improve patient care by bringing to light how multidisciplinary care in combination with the minimally invasive procedures IR offers can significantly improve overall patient survival for those with HCC and ensure future health care resources are appropriately allocated to support these measures," she said.
Querying the Database
The researchers obtained data from a national database that contains VA medical records for patients who have been diagnosed with HCC. They selected all patients who have been treated for HCC from 2008-2020.
They evaluated the number of IR procedures or clinic visits over time using logistic regression for coefficient of the slope. Next, they split patients into two groups Group A (those diagnosed from 1/1/2006–12/31/2011, who had minimal access to IR services) and Group B (those diagnosed from 1/1/2012–12/31/2017, who had increasing access to IR services).
The investigators evaluated overall survival of these two groups using Kaplan-Meier survival analysis with censoring at death, last contact date or five years of follow-up. They calculated the P-value using a log-rank test. Lastly, they evaluated overall survival of patients with HCC at a single VA site prior to and after the implementation of an interventional oncology (IO) program which included tumor board, IR clinic and IR based procedures. These were compared against negative controls which included VA sites that had not implemented an IO program.
Drawing Conclusions
A total of 62,658 patients received an HCC diagnosis from 2008 to 2020. Of these patients, 4,380 underwent ablation, 916 underwent radioembolization and 9,734 underwent chemoembolization. Nationwide, IR clinic/procedure visits in the VA health care system for HCC patients went up from 736 in 2006 to 9,535 in 2019.
Importantly, patients in Group B (those who had increasing access to IR services) showed an increase in median overall survival (766 days, 95% CI, 738–796) compared to Group A (469 days, 95% CI, 445–491). They also showed through the single site study that overall survival is significantly improved after implementation of an IO program (374 vs. 641 days, p = 0.044). This increase in survival was not seen at the sites that had not implemented a program.
"Research into how developing treatments impact overall patient outcomes and survival is extremely important," Dr. Martin said. "Despite our best efforts to develop new treatments that theoretically would have better patient outcomes, there are often factors that we do not anticipate and may negatively impact patients. Therefore, retrospective reviews of the changes we have made are essential to determine if we are on the right path to helping our patients."
As health care transitions to more minimally invasive procedures and increased multidisciplinary patient care, she added, "we must prove to others that these are the correct steps forward and to ensure that those in charge of health care resources know our value and allocate resources accordingly."
Access the presentation, "Quantifying the Value of Interventional Radiology: National Utilization of Interventional Radiology for Hepatocellular Carcinoma from 2006-2020 in the Veterans Health Administration and Impact on Overall Survival," (M7-SSIR01-6) on demand at Meeting.RSNA.org.
Percent change in procedures used for treatment of hepatocellular carcinoma over time. TACE = transarterial chemoembolization. Image courtesy of Lynne Martin, MD
