Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Mar;65(3):875-884.
doi: 10.1002/hep.28770. Epub 2016 Oct 1.

Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Sherean Farvardin  1 , Jaimin Patel  1 , Maleka Khambaty  1 , Olutola A Yerokun  1 , Huram Mok  1 , Jasmin A Tiro  2   3 , Adam C Yopp  2   4 , Neehar D Parikh  5 , Jorge A Marrero  1 , Amit G Singal  1   2   3
Affiliations
Comparative Study

Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Sherean Farvardin et al. Hepatology. 2017 Mar.

Abstract

Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.25-7.62) and significantly lower in those reporting barriers to surveillance (OR, 0.42; 95% CI, 0.25-0.70).

Conclusion: Patients with cirrhosis are knowledgeable and interested in HCC surveillance; however, patient-reported barriers are associated with lower surveillance rates in clinical practice and represent potential intervention targets to improve HCC surveillance effectiveness. (Hepatology 2017;65:875-884).

PubMed Disclaimer

Conflict of interest statement

Potential conflict of interest: Dr. Singal consults for and is on the speakers’ bureau for Bayer. Dr. Yopp is on the speakers’ bureau for Bayer and received grants from Novartis and Peregrine.

Figures

FIG. 1
FIG. 1
Model of patient behavior for HCC surveillance.
FIG. 2
FIG. 2
Patient-reported barriers to HCC surveillance.
See this image and copyright information in PMC

Comment in

References

    1. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–2576. - PubMed
    1. Singal AG, Marrero JA. Recent advances in the treatment of hepatocellular carcinoma. Curr Opin Gastroenterol. 2010;26:189–195. - PubMed
    1. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27:1485–1491. - PMC - PubMed
    1. Ha J, Yan M, Aguilar M, Bhuket T, Tana M, Liu B, et al. Race/ethnicity-specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the U. S Cancer. 2016;122:2512–2523. - PubMed
    1. Sloane D, Chen H, Howell C. Racial disparity in primary hepatocellular carcinoma: tumor stage at presentation, surgical treatment and survival. J Natl Med Assoc. 2006;98:1934–1939. - PMC - PubMed

Publication types

MeSH terms