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Dr Michael Morse Discusses Gaps in Care Access, Equity in HCC


Michael Morse, MD, FACP, MHS, medical oncologist at Duke Cancer Center, explained gaps in care access and equity that must be addressed to ensure all patients with liver cancer can get the treatments they need.

Michael Morse, MD, FACP, MHS, professor of medicine at Duke University School of Medicine and medical oncologist at Duke Cancer Center, explained gaps in care access and equity that need to be addressed to ensure all patients with liver cancer can get the care and treatments they need.


What gaps need to be addressed to improve equity and access to care for patients with liver cancer?

One of the most critical aspects of the best outcome for any patient across any demographics is really getting a multidisciplinary evaluation because we have many therapies for cancer and liver cancer. We have surgeries, ablations, locoregional therapies that involve vascular delivery of therapies, and then we have systemic therapies, and of course, transplant as well—and I don't think any one clinician can know for certain whether one or another strategy is absolutely the best for a particular patient, and whether to discount any.

There are some obvious metrics: if you have very advanced disease, you're not going to be a transplant candidate, for example. I think it's still very helpful for people to get that multidisciplinary evaluation of some sort. It doesn't necessarily have to be in a particular clinic, doesn't have to necessarily be a conference, but that just discussions have been held—and obviously taking into account patient preferences as well, and their comorbidities. That's really going to drive outcomes.

One of the problems is many people don't have access to all of those opinions, and I think that's really where the effort needs to be put into. Although there certainly could be biases, both historical and contemporary, and financial issues, and other social issues that certainly do impact care—we have to try to mitigate those as much as we possibly can—it's ultimately reflected in whether people get that full review, and then once they get the review, are able to get the particular therapy that appears to be best for them.

And then once they've had a particular therapy, keep asking those questions, because now that we have more effective systemic therapies, for example, we are seeing people who can go back and have a locoregional therapy or even a surgery in rare instances, or transplant. I think that it's important that people also still have access to centers that can provide all this care, at least opinions, to people. So, how do we make sure that people that aren't in a major center, or it's more challenging to make the trip, or financially you're having difficulty accessing those drugs [can get access]? Obviously, we have to work on all of those problems.

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