Patient-Reported Barriers to HCC Surveillance

More than 20% of patients with cirrhosis do not receive the recommended semi-annual hepatocellular carcinoma (HCC) surveillance owing to a large variety of patient reported barriers, a new study published in Clinical Gastroenterology and Hepatology revealed.

“Patient-reported barriers such as knowledge deficits, costs, difficulty scheduling, and transportation are significantly associated with less frequent receipt of HCC surveillance, indicating a need for patient-centered interventions, such as patient navigation,” the authors wrote.

Data collected from a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) through telephone survey was used to identify barriers associated with HCC surveillance receipt during a period of 1 year.

Results from 1020 patients revealed a high level of concern about developing HCC and high levels of knowledge about the condition among patients. However, the researchers also found that a lot of patients had knowledge deficits such as believing “surveillance was unnecessary when physical examination and laboratory results were normal.”

The top barriers to surveillance were costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%).

Additionally, the authors found that in the year before the survey, “745 patients (73.1%) received 1 or more surveillance examination; 281 received on-schedule, semi-annual surveillance and 464 received annual surveillance.”

The 6-month HCC surveillance was directly associated when hepatology subspecialty care was received (odds ratio, 30.1; 95% CI, 17.5–51.8), and inversely associated with patient-reported barriers (odds ratio, 0.62; 95% CI, 0.41–0.94)

—Priyam Vora

Reference:
Singal A, Tiro J, Murphy C et al. Patient-reported barriers are associated with receipt of hepatocellular carcinoma surveillance in a multicenter cohort of patients with cirrhosis. Clin Gastroenterol Hepatol. Published online: July 03, 2020. DOI: https://doi.org/10.1016/j.cgh.2020.06.049