Closing Equity Gaps in Cirrhosis and Liver Cancer Care

Personal experience and social factors impact patient care for cirrhosis and liver cancer, but changes to patient-physician relationships, health education and screening access can benefit the patient, according to two studies published in Clinical Gastroenterology and Hepatology from the UT Southwestern Medical Center’s Division of Digestive and Liver Diseases.

Discrimination and medical mistrust are common experiences for Black people with cirrhosis, according to the first study. The second study highlighted the importance of regular screening, health literacy and good communication in detecting and treating hepatocellular carcinoma (HCC), the most common type of liver cancer, which is often detected at late stages, when it is difficult to treat.

“Together, these studies point to the same conclusion, namely, improving trust, communication and access could help close long-standing gaps in liver disease and liver cancer outcomes,” said Amit Singal, MD, MS, the senior author of both studies, in a UT Southwestern news release.

Over time, chronic hepatitis B, hepatitis C, heavy alcohol consumption and metabolic dysfunction-associated fatty liver disease (MASLD) can lead to serious liver complications, including cirrhosis and HCC.

In the first study, the researchers surveyed over 1,000 people diagnosed with cirrhosis to assess discrimination and medical mistrust. They also measured health literacy based on how often a patient needed help understanding health care information and factored in ethnic and racial identity, socioeconomic status and health outcomes.

Experiencing discrimination was more common for both Black and Latino people, but only Black people had higher medical mistrust. Similarly, social determinants of health, such as lower income and health literacy, were associated with discrimination.

While race and ethnicity or socioeconomic status did not predict the short-term health outcomes of patients, the findings are still important for increasing health care access and trust between patients and physicians.

“These factors may influence intermediate health behaviors, such as clinic attendance, screening adherence and treatment engagement,” wrote the study’s authors.

The second study followed over 800 patients throughout their diagnosis with and treatment for HCC to understand how race, ethnicity and social determinants of health impact cancer screening and early-detection of HCC.

Regardless of such factors, HCC was detected earlier in patients who received routine cancer screenings, and patients with higher health literacy were more likely to get screened. Patients who reported better communication with their team were diagnosed with HCC earlier.

“The Division’s research program is already shaping efforts to strengthen patient-provider communication, improve health education and make surveillance easier to access, with the goal of ensuring that all patients receive timely, effective care,” said Singal.