The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study

Background: The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. This study evaluated the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. Methods: The National Cancer Database was queried for patients diagnosed with clinical stages I–IV HCC from 2017–2020. Patients were categorized by year of diagnosis as Pre-COVID (2017–2019) and COVID (2020). TTI by stage and first treatment received was compared using the Mann-Whitney U test. Logistic regression evaluated factors associated with increased TTI and treatment delay (>90 days). Results: 18,673 patients were diagnosed Pre-COVID and 5249 during COVID. Median TTI for any first-line treatment was slightly shorter during COVID versus Pre-COVID (49 vs. 51 days; p < 0.0001), notably for ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In multivariate analysis, Black race (IRR 1.057; 95% CI 1.022–1.093; p = 0.0013), Hispanic ethnicity (IRR 1.045; 95% CI 1.010–1.081; p = 0.0104), and uninsured/Medicaid/Other Government insurance (IRR 1.088; 95% CI 1.053–1.123; p < 0.0001) were associated with increased TTI; these groups were also associated with delayed treatment. Conclusions: For patients diagnosed during COVID, TTI for HCC showed statistically but not clinically significant differences compared with Pre-COVID. Vulnerable patients were more likely to experience increased TTI and delays.