Spotlighting Disparities in Pediatric Liver Cancer Treatment

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Jonathan Hills-Dunlap, MD, MPH, assistant professor of pediatric surgery at the University of Colorado Department of Surgery, has long been interested in health care disparities, in particular how racial and socioeconomic differences affect the surgical care that children receive.

“Kids are kids,” he says. “They should be treated exactly the same no matter the color of their skin, where they were born, what language they or their parents speak, or what jobs their parents have.”

Disparities in treating deadly tumors

In a new study published in February in the Journal of Pediatrics, Hills-Dunlap looked at how those sociodemographic factors influenced the surgical management of two types of liver tumors: hepatoblastoma and hepatocellular carcinoma. 

Reasons why and why not

The National Cancer Database data does offer some reasons why surgery may not have been performed in 201 cases within the study — either surgery was not part of the planned first-course treatment or because of contraindications due to patient risk factors — but Hills-Dunlap says there likely are other reasons for the treatment disparity, particularly when race and insurance status are factored into the equation. 

Other issues that may keep Black patients and those on Medicaid from receiving the care they need include poor health literacy, lack of access to specialized care, and lack of adequate time off from work to take children to appointments, Hills-Dunlap says. 

Finding solutions

Hills-Dunlap hopes that his new paper on disparities in liver cancer treatment, along with a similar paper he published in 2019 on disparities in umbilical hernia surgery, gets other surgeons talking not just about disparities, but about ways to address them.

“This is very much a health-equity issue — the disparity exists, we’ve identified it, but how do we make sure this vulnerable, at-risk population gets the care they need?” he says. “We are told all patients should be treated equally, but what this paper and others are trying to convey is that some patients may actually need more help. We need to treat them differently, but in a positive way so that ultimately their outcomes can be the same as every other child.”


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