Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States.

Abstract

BACKGROUND & AIMS:

Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers' opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient's HCC risk on the choice of surveillance modality.

METHODS:

We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states.

RESULTS:

Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient's HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001).

CONCLUSIONS:

Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients' estimated HCC risk, instead of our current "one-size-fits all" strategy.

• Authors: Nicole J Kim, Karine Rozenberg-Ben-Dror, David A Jacob, Nicole E Rich, Amit G Singal, Elizabeth S Aby, Ju Dong Yang, Veronica Nguyen, Anjana Pillai, Michael Fuchs, Andrew M Moon, Hersh Shroff, Parul D Agarwal, Ponni Perumalswami, Shaun Chandna, Kali Zhou, Yuval A Patel, Nyan L Latt, Robert Wong, Andres Duarte-Rojo, Christina C Lindenmeyer, Catherine Frenette, Jin Ge, Neil Mehta, Francis Yao, Jihane N Benhammou, Patricia P Bloom, Michael Leise, Hyun-Seok Kim, Cynthia Levy, Abbey Barnard, Mandana Khalili, George N Ioannou
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 20 Issue 1 Pg. 183-193 (01 2022) ISSN: 1542-7714 [Electronic] United States
• PMID: 32927050 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2022 AGA Institute. All rights reserved.

Chemical References

• alpha-Fetoproteins

Topics

• Attitude of Health Personnel
• Carcinoma, Hepatocellular (diagnosis, epidemiology)
• Diagnostic Tests, Routine
• Early Detection of Cancer
• Humans
• Liver Cirrhosis (complications)
• Liver Neoplasms (diagnosis, epidemiology)
• Ultrasonography
• United States
• alpha-Fetoproteins