Disparities in hepatocellular carcinoma outcomes by distance, insurance, and treatment access: A 10-year retrospective study in Nevada.

482 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in the United States, with rising incidence and disproportionate impact on socioeconomically disadvantaged populations. Timely diagnosis and access to multidisciplinary treatment are critical for improving survival. However, structural barriers such as geographic distance from cancer centers, lack of insurance, and limited access to treatment may contribute to poor outcomes. Nevada, a large and medically underserved state, offers a unique opportunity to examine these factors at a population level. We evaluated how distance to care, insurance status, and treatment receipt affect survival among patients with HCC. Methods: We conducted a retrospective cohort study of n=1,911 patients diagnosed with HCC in Nevada from 2009-2019 using data reported to the Nevada Central Cancer Registry. Patients were categorized by distance to the nearest tertiary cancer center (20-50, >50 miles), insurance status (public, private, uninsured), and treatment status (received vs. not received). Survival time was compared using the Kruskal-Wallis test. Treatment rates across distance categories were compared using Chi-square analysis. Results: Patients living >50 miles from a tertiary center had the shortest median (Mdn) survival (Mdn=67.5 days), significantly lower than those living 10-20 miles away (Mdn=218 days, p =0.028). The >50 miles participants also had the highest rate of no treatment (42.2%) compared to 28.4% in the 10-20 mile group. Uninsured patients had significantly worse survival (Mdn=55.5 days) compared to publicly (Mdn=193 days) and privately insured patients (Mdn=246.5 days, p