PMID- 26374349
OWN - NLM
STAT- MEDLINE
DCOM- 20160830
LR  - 20221207
IS  - 1477-2574 (Electronic)
IS  - 1365-182X (Print)
IS  - 1365-182X (Linking)
VI  - 17
IP  - 12
DP  - 2015 Dec
TI  - Missing the obvious: psychosocial obstacles in Veterans with hepatocellular 
      carcinoma.
PG  - 1124-9
LID - 10.1111/hpb.12508 [doi]
AB  - 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.
CI  - (c) 2015 International Hepato-Pancreato-Biliary Association.
FAU - Hwa, Kimberly J
AU  - Hwa KJ
AD  - Department of Surgery, Palo Alto Veterans Affairs, Palo Alto, CA, USA.
FAU - Dua, Monica M
AU  - Dua MM
AD  - Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
FAU - Wren, Sherry M
AU  - Wren SM
AD  - Department of Surgery, Palo Alto Veterans Affairs, Palo Alto, CA, USA.
AD  - Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
FAU - Visser, Brendan C
AU  - Visser BC
AD  - Department of Surgery, Palo Alto Veterans Affairs, Palo Alto, CA, USA.
AD  - Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
LA  - eng
PT  - Journal Article
DEP - 20150916
PL  - England
TA  - HPB (Oxford)
JT  - HPB : the official journal of the International Hepato Pancreato Biliary 
      Association
JID - 100900921
SB  - IM
MH  - California/epidemiology
MH  - Carcinoma, Hepatocellular/economics/epidemiology/pathology/psychology/*therapy
MH  - Comorbidity
MH  - *Health Behavior
MH  - *Health Knowledge, Attitudes, Practice
MH  - Health Services Accessibility
MH  - *Healthcare Disparities/economics
MH  - Ill-Housed Persons/psychology
MH  - Humans
MH  - Income
MH  - Liver Neoplasms/epidemiology/genetics/pathology/psychology/*therapy
MH  - Mental Disorders/epidemiology/psychology
MH  - Middle Aged
MH  - Prevalence
MH  - Residence Characteristics
MH  - Retrospective Studies
MH  - Substance-Related Disorders/epidemiology/psychology
MH  - Transportation of Patients
MH  - Treatment Outcome
MH  - Unemployment/psychology
MH  - Veterans/*psychology
MH  - *Veterans Health/economics
PMC - PMC4644365
EDAT- 2015/09/17 06:00
MHDA- 2016/08/31 06:00
PMCR- 2016/12/01
CRDT- 2015/09/17 06:00
PHST- 2015/03/25 00:00 [received]
PHST- 2015/07/30 00:00 [accepted]
PHST- 2015/09/17 06:00 [entrez]
PHST- 2015/09/17 06:00 [pubmed]
PHST- 2016/08/31 06:00 [medline]
PHST- 2016/12/01 00:00 [pmc-release]
AID - S1365-182X(15)32028-1 [pii]
AID - 10.1111/hpb.12508 [doi]
PST - ppublish
SO  - HPB (Oxford). 2015 Dec;17(12):1124-9. doi: 10.1111/hpb.12508. Epub 2015 Sep 16.