Date of Award


Degree Type


Degree Name

Master of Public Health


School of Public Health

First Advisor

Kristine Lukens


Objective: To assess and provide in-depth analysis of appropriate delivery of care in patients with hepatocellular carcinoma (HCC) based on time of diagnosis within Americans in the United States. Design: Meta-analysis of retrospective cohort studies describing receipt of appropriate treatment utilization and delivery of care for HCC. Results: Among all twenty-three included studies, a total of 7,986 of 17,286 (44.4%, 95% CI 43.7-45.1%) patients received overall treatment. Of 48,200 patients with HCC, only 10,518 (21.8%, 95% CI 21.5-22.2%) patients received curative treatment and 6,810 of 11,776 (57.8%, 95% CI 56.9-58.7%) patients who were within early stage HCC received curative treatment. Conclusion: HCC treatment is underutilized in the United States. Although the pooled treatment rate for early HCC patients receiving curative treatment is somewhat better, only about four-sevenths receive appropriate care. There are significant socio-demographic disparities with the lowest treatment rates in non-Caucasians and non-private insurance patients.


Tan, Debra, Appropriate Delivery Of Care In American Patients With Hepatocellular Carcinoma: A Systematic Review. Master of Public Health, May 2013, 36 pp., 3 tables, 7 figures, references cited, 42 titles.