Effective Practices in Multidisciplinary Hepatocellular Carcinoma Care

J Clin Pathways. 2022;8(2):19.

Hepatocellular carcinoma (HCC) is one of the most challenging cancers to diagnose and treat.¹ In 2020, the National Cancer Institute (NCI) estimates that there will be 42,810 new cases of liver and intrahepatic bile duct cancers and 30,160 deaths in the United States.² About 75 percent of these cases are HCC.³ Despite rising incidence rates and an estimated 89,950 people living with liver cancer or hepatic bile duct cancer,² there is little information available on managing patients with HCC in community cancer programs.⁴ 

To learn more about current practices in HCC care management, the Association of Community Cancer Centers (ACCC) launched the Multidisciplinary Hepatocellular Carcinoma Care education program in partnership with the Cancer Support Community (CSC), the American Cancer Society (ACS), the Global Liver Institute (GLI), the Society of Interventional Radiology, and Blue Faery: The Adrienne Wilson Liver Cancer Association.

As part of this education program ACCC researched and published a comprehensive environmental scan that identified six effective practices in managing patients with HCC: 

1. Follow national HCC guidelines for testing, staging, and treatment.
2. Work with a dedicated hepatobiliary and transplant multidisciplinary team or collaborate with an external expert tumor board. 
3. Conduct regular multidisciplinary evaluations of HCC cases. 
4. Establish operational pathways to document adherence to guidelines and quality of care metrics. Promote and support screening through communication and education with community clinicians.
5. Provide patient-centered care by participating in shared decision-making.

Next ACCC collaborated with the project’s expert Advisory Committee and Partner Organizations to select and highlight three cancer programs in various care settings to how they have implemented these—and other—effective practices.

Sharp HealthCare is a not-for-profit health system serving San Diego County. Within the system are four acute care hospitals, three specialty hospitals, and three affiliated medical groups. To improve the care and management of patients with HCC the healthcare system recommends:

• Formalize internal operational pathways to standardize care.
• Work as a decentralized team to improve care coordination.
• Improve health literacy and patient engagement in decision-making.

Mercy Medical Center is an urban community hospital with an academic affiliation with the University of Maryland School of Medicine. Care for patients with HCC is coordinated through The Center for Liver and Hepatobiliary Disease at The Melissa L. Posner Institute for Digestive Health and Liver Disease. Mercy Medical Center shares these effective practices:

• Optimize communication and patient coordination using a multidisciplinary conference.
• Leverage external resources to provide comprehensive services.
• Increase access through outreach clinics.

The Emory Liver Tumor Clinic, a joint initiative involving the Emory Transplant Center and Winship Cancer Institute of Emory University in Atlanta recommends these effective practices:

• “Cluster” care to improve the patient experience.
• Hire a dedicated clinic coordinator.
• Include medical oncology in the HCC Clinic.