Summary
This study is a pilot, multi-center randomized controlled trial testing the HCC Liver-Link intervention, a culturally tailored, multi-level program designed to reduce racial disparities in hepatocellular carcinoma (HCC) care. The intervention combines: (1) patient education to improve HCC-related disease and treatment knowledge, (2) social needs and substance use screening with referral to social work and community resources, and (3) facilitated access to subspecialty cancer care through a multidisciplinary HCC tumor board.
A total of 40 Black patients with Barcelona Clinic Liver Cancer (BCLC) stage 0, A, or downstaged B disease will be randomized to receive either the HCC Liver-Link intervention or usual care and followed for 6 months or until liver transplant waitlisting. Primary outcomes are time to receipt of curative therapies (liver transplantation or resection) and change in HCC-related knowledge. Findings will inform development of larger interventions to eliminate racial disparities in HCC outcomes.
Eligibility Criteria
Age Range: 18 years to 75 years
Inclusion Criteria
• Within UCSF criteria:
Candidates are eligible or a standardized MELD or PELD exception if, before completing locoregional therapy, they have lesions that meet one of the following criteria:
* One Class 5 lesion greater than 5 cm and less than or equal to 8 cm
* two or three Class 5 lesions that meeting all of the following
* At least one lesion greater than 3cm
* Each lesion less than or equal to 5 cm, and
* A total diameter of all lesions less than or equal to 8cm
* Four or five Class 5 lesions each less than 3 cm, and a total diameter of all lesions less than or equal to 8 cm.
* Between 18-75 years old
* Have no more than two visits with an HCC-related provider
* Able to read, write, and speak English
* Any 1 of the following:
* Self-report as Black race (can be multiple races as long as 1 is Black)
* Self-report as insured by Medicaid (+/- Medicare)
* SVI (Social vulnerability index) \>= .75
* Unmarried
Exclusion Criteria
* Lacks capacity to provide informed consent, including those with stage 2 HE or higher at the time of consent.
* Age over 75
* Last transthoracic echocardiogram with EF\<40% (OK if no prior echo)
* BMI over 50
* Patients who, in the investigator's judgment, are unlikely to ever be eligible for liver transplantation or resection at the time of enrollment, with reason documented
* Prior history of any solid organ transplant
* Non-skin cancer malignancies other than hepatocellular carcinoma in past 2 years unless approved by PI (i.e. cervical cancer, early prostate cancer)
* Patients who have undergone resection or waitlisted
* Patients near completion of transplant evaluation, PI to determine utility of intervention.