Nicole J Kim1, Karine Rozenberg-Ben-Dror2, David A Jacob3, Nicole E Rich4, Amit G Singal4, Elizabeth S Aby5, Ju Dong Yang6, Veronica Nguyen7, Anjana Pillai8, Michael Fuchs9, Andrew M Moon10, Hersh Shroff11, Parul D Agarwal12, Ponni Perumalswami13, Shaun Chandna14, Kali Zhou15, Yuval A Patel16, Nyan L Latt17, Robert Wong18, Andres Duarte-Rojo19, Christina C Lindenmeyer20, Catherine Frenette21, Jin Ge22, Neil Mehta22, Francis Yao22, Jihane N Benhammou23, Patricia P Bloom24, Michael Leise25, Hyun-Seok Kim26, Cynthia Levy27, Abbey Barnard28, Mandana Khalili22, George N Ioannou29. 1. Division of Gastroenterology, University of Washington, Seattle, Washington. Electronic address: nkim8@medicine.washington.edu. 2. Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, Westchester, Illinois. 3. Veteran Affairs Heart of Texas Health Care Network, VISN 17 PBM, Temple, Texas. 4. Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas. 5. Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota. 6. Division of Digestive and Liver Diseases, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California. 7. Division of Gastroenterology, University of Arizona, Tucson, Arizona. 8. Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois. 9. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Hepatology Section, Central Virginia Veteran Affairs Health Care System, Richmond, Virginia. 10. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina. 11. Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois. 12. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 13. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York. 14. Division of Gastroenterology, Hepatology, and Nutrition, University of Utah, Salt Lake City, Utah. 15. Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California. 16. Division of Gastroenterology, Duke University, Durham, North Carolina. 17. Ochsner Multi-Organ Transplant Institute, Division of Gastroenterology, Ochsner Health, New Orleans, Louisiana. 18. Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California. 19. Division of Gastroenterology, University of Pittsburgh, Pittsburgh, Pennsylvania. 20. Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio. 21. Division of Organ Transplantation, Scripps Green Hospital, La Jolla, California. 22. Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California. 23. Division of Gastroenterology, University of California Los Angeles, Los Angeles, California. 24. Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts. 25. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 26. Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas. 27. Division of Gastroenterology and Hepatology, University of Miami, Miami, Florida. 28. Division of Gastroenterology, University of California San Diego, La Jolla, California. 29. Division of Gastroenterology, University of Washington, Seattle, Washington; Division of Gastroenterology, Veteran Affairs Puget Sound Health Care System, Seattle, Washington.
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.
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: Elliot B Tapper; Shengchen Hao; Menghan Lin; John N Mafi; Heather McCurdy; Neehar D Parikh; Anna S Lok Journal: Hepatology Date: 2019-06-21 Impact factor: 17.425
Authors: So Yeon Kim; Jihyun An; Young-Suk Lim; Seungbong Han; Ji-Young Lee; Jae Ho Byun; Hyung Jin Won; So Jung Lee; Han Chu Lee; Yung Sang Lee Journal: JAMA Oncol Date: 2017-04-01 Impact factor: 31.777