Are We Closing the Gap? A Review of Health Equity Focused Interventions Along the Liver Cancer Care Cascade in the US

OBJECTIVES: Medically underserved and racial/ethnic minorities with liver cancer have higher mortality risks than non-marginalized groups. Health disparities are well-documented along the care cascade, yet the effectiveness of equity-focused programs remains uncertain. This review sought to identify and characterize evidence-based interventions implemented in the US to address health disparities in patients with liver cancer.

METHODS: A targeted literature review was performed using PubMed (MEDLINE) database. Original research studies of interventions targeted at preventing liver cancer, improving care and addressing disparities published between 2018 and 2023 were included in this review. Epidemiology studies, ex-US, or papers without a documented intervention were excluded. Interventions were characterized by level (patient, provider, organization, system), care cascade target (risk reduction, screening, surveillance, diagnosis, care delivery), and measurement of effectiveness.

RESULTS: Over 600 papers were identified, and 20 studies meeting inclusion criteria were included in the final review. Study populations were racial and ethnic minorities, safety-net, under/uninsured, rural and low-income patients. Screening was the most frequently addressed point of care (n=10), followed by care delivery (n=8), and the interventions were most commonly implemented at the organization level (n=9). Education programs were the most common type of intervention (n=6). Positive impact by the intervention was reported in 19 out of 20 studies. Only one study measured and reported improved overall survival.

CONCLUSIONS: Few programs have targeted health disparities in patients at-risk or with liver cancer. Most interventions focused on screening and utilized education tools. While the majority of studies reported positive findings, this review highlighted gaps in addressing later stages of the care cascade, including diagnosis and care delivery in patients with liver cancer. These findings may be used to identify where future interventions are needed and assess feasibility. Further research should be done to evaluate which interventions are most effective with limited health care resources.