October is Liver Cancer Awareness Month, an important opportunity to shed light on a growing challenge. Hepatocellular carcinoma (HCC) accounts for approximately 75 percent of all liver cancers in the U.S. It is a complex disease to treat, and oncologists often depend on deploying precise care coordination across a diverse team over an extended period. 

Multidisciplinary approaches that include partnerships with specialists is critical to managing a patient’s care. This month, ACCC is launching several resources as part of its Multidisciplinary Heptocellular Carcinoma Education Program. The program is the result of a partnership between ACCC and the Cancer Support Community, the American Cancer Society, the Global Liver Institute, the Society of Interventional Radiation Oncology, and Blue Faery: The Adrienne Wilson Cancer Association.  

Creating the Heatmap 

Patients’ race, socioeconomic status, and geographic location can all influence their access to cancer treatments and their treatment outcomes, and liver cancer is no exception. Especially in the case of liver cancer, access to specialists can depend on where a patient lives.  

To better understand the current incidence, mortality rates, and health disparities for those with HCC, ACCC has developed a liver cancer heatmap. ACCC used information on liver cancer rates from 2012-2016 from the Centers for Disease Control and Prevention’s U.S. Cancer Statistics to develop the heatmap, which can be searched by age-adjusted rates, crude rates, number of cases, mortality, and mortality-to-incidence ratio. The locations of National Cancer Institute (NCI) designated cancer centers and ACCC member cancer programs are incorporated into the map to indicate where treatment facilities are in each state. Users can combine information by category and state to view statistics on liver cancer in specific geographic regions. 

Three members of ACCC’s HCC Advisory Committee—Tiffany Brosius, RN-BSN, OCN, GI Navigator at Emory Winship Cancer Institute; Nadine Abi-Jaoudeh, MD, Professor of Radiological Sciences at the University of California Irvine School of Medicine; and Andrea Wilson-Woods, President and Founder of Blue Faery: The Adrienne Wilson Liver Cancer Association—shared some ideas of how different organizations can put the heatmap to work for them:

Cancer Programs
It is useful for individual cancer programs to know what’s happening in their state beyond their own program’s reach. Cancer programs in states with high mortality or high mortality-to-incidence ratios may want to identify ways to work with their communities to support early detection and decrease barriers to care. Knowing the locations of other cancer programs can open opportunities to coordinate for providers and patients alike.  

I see the heatmap being used as a source of networking between institutions. I could also see this heatmap utilized as a way to help patients find a medical facility to help navigate their care close to home, as transportation can be a barrier to care.
- Tiffany Brosius RN-BSN, OCN

State or Regional Cancer Coalitions
Having good data can help focus efforts at the state or regional level. For example, if incidence is high in a specific state, a state cancer committee may use this information to offer recommendations or provide resources to regional practices and programs. 

A state or local cancer committee could use this map as a resource to know where to focus initiatives. For example, a cancer committee could work within their respective state or region to help the cancer programs form relationships with the more underdeveloped areas.
- Tiffany Brosius RN-BSN, OCN

State-level crude rates can also provide useful information for planning purposes.  

State and local authorities should use this in terms of resource allocation.
- Nadine Abi-Jaoudeh, MD

Nonprofit Organizations
For national nonprofit organizations, heatmap information is a useful tool to target resources to patients, family, and providers. Knowing where the highest incidence, mortality, and mortality-to-incidence ratios are enables organizations to use their limited resources in the most effective way.  

This information will directly affect our marketing outreach for our HCC community.
- Andrea Wilson-Woods

Researchers
There’s no question that clinical trials improve cancer care, and access to national data trends can help strengthen and target that research.

I think that cancer programs can determine possible participation in research projects. Our cancer center, for example, has a grading scale and potential recruitment to trials is judged. Knowing that your state has very little or a greater number of a particular cancer would help. Usually they rely on historical numbers in the institution, but having complementary data on regional incidence/prevalence would be of interest. It would be very useful to sponsor organizations assessing for sites for trials.
- Nadine Abi-Jaoudeh, MD

New Opportunities
The data revealed by ACCC’s liver cancer heatmap could serve as a foundation for additional capabilities that answer specific queries about the intersection of HCC with other factors.

I would be interested in more granular data such as causes of HCC, for example, between hepatitis incidence and treatment, correlation with NASH, alcohol use, and cirrhosis. It would be interesting to correlate with race and gender. Are there problematic states that would benefit from a specific intervention, or is it a generalized problem? Even more details that could be available on the heatmap would be helpful.
- Nadine Abi-Jaoudeh, MD 

Additional Resources 

Although the incidence of HCC is rising, most cancer programs do not have a specialized multidisciplinary team for this type of cancer. ACCC's HCC resources page includes screening and treatment guidelines, training opportunities, patient education, clinical trials, and more, providing valuable information to build expertise in treating HCC.