b'Hepatocellular Carcinoma Treatment, Survival Varies Among VA Regions Veterans have higher rates of cirrhosis, hepatitis C infection, obesity, high alcohol use and diabetesall of which put them at greater risk of hepatocellular carcinoma. Treatment is challenging, and a new study found that it tends to be inconsistent across regions within VA healthcare, with the West providing more interventions and having better survival rates.By LaTina EmersonWASHINGTON, D.C.Veterans are five times asTheretrospectivestudypublishedinthejournal likelytohavehepatocellularcarcinoma,themostAnnals of Surgical Oncology used the VA Corporate common type of liver cancer, compared to the gen- Data Warehouse to build a comprehensive national eral population, and a recent study has found differ- dataset of veteran patients with hepatocellular carci-ences in treatment patterns and overall survival ratesnoma diagnosed between 2001 and 2015 to compare across the VAs five geographic regions. patients across VAHS regions. 1In2021,about2,000veteransinVAcarewereThe study analyzed 13,434 patients and found the diagnosed with hepatocellular carcinoma, accordingWest region had the highest rate of overall treatment to a VA spokesperson.receipt (63.6%), and the Southwest had the lowest VA enrollees have a higher incidence of hepato- rate (52.9%). After adjusting for demographic, clini-cellular carcinoma (HCC) because they have highercopathologic, treatment and hospital factors, treat-rates of most of the important risk factors for HCC,ment in a non-West region continued to be signifi-a VA spokesperson told U.S. Medicine. For exam- cantly associated with a 10% to 13% increased risk ple, compared to the general population, VA enroll- of five-year mortality, according to the study. ees have higher rates of cirrhosis, hepatitis C infec- The researchers concluded that treatment patterns tion, obesity and diabetes. Another factor is the riskand overall survival rates of hepatocellular carci-of alcohol use is higher in veterans, in part related tonomapatientsdiffersignificantlyacrossVAHS trauma. geographic regions. They suggested that targeted Finally, metabolic risk factors for nonalcoholicinterventions to increase the rate of treatment in fatty liver disease are higher in veterans than civil- the non-West regions are needed to improve sur-ianpopulationsduetoagentorangeexposure.vivalofveteranswithhepatocellularcarcinoma Other factors that are associated with increased riskandprovideuniformlyhigh-qualitycareacross of HCC are being male and older, both of which areVAHS facilities.higher among the veteran population in comparisonVA is committed to providing veterans the soon-to the general population. estandbestcare,the VAspokespersonwrotein Treatment of hepatocellular carcinoma is challeng- anemail.Wecarefullyreviewvariationsincare ing,theVAspokespersonexplainedinanemail.between VA medical centers and across regions and There are multiple treatment options and choosing theare involved in a continuous process of closing gaps appropriate treatment for each patient is time-consum- as the evidence emerges.ing and complicated. Most patients with hepatocellu- Investigatingimprovedtechniquesfordiagnos-lar carcinoma can receive palliative, locoregional oring liver cancer is a high research priority, accord-potentially curable treatment. However, hepatocellu- ing to the VA spokesperson. This year, the VA has lar carcinoma recurs in the majority of veterans withinlaunched one of the largest liver cancer screening two to three years of treatment. research studies in its history. The focus of the work Continued on Page 71 u58'