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
Multicenter Study
. 2021 May;19(5):987-995.e1.
doi: 10.1016/j.cgh.2020.06.049. Epub 2020 Jul 3.

Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis

Amit G Singal  1 , Jasmin A Tiro  2 , Caitlin C Murphy  2 , James-Michael Blackwell  2 , Jennifer R Kramer  3 , Aisha Khan  3 , Yan Liu  3 , Song Zhang  2 , Jessica L Phillips  2 , Ruben Hernaez  4
Affiliations
Multicenter Study

Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis

Amit G Singal et al. Clin Gastroenterol Hepatol. 2021 May.

Abstract

Background: More than 20% of patients with cirrhosis do not receive semi-annual hepatocellular carcinoma (HCC) surveillance as recommended. Few studies have evaluated the effects of patient-level factors on surveillance receipt.

Methods: We administered a telephone survey to a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) to characterize patient knowledge, attitudes, and perceived barriers of HCC surveillance. Multinomial logistic regression was performed to identify factors associated with HCC surveillance receipt (semi-annual and annual vs none) during the 12-month period preceding survey administration.

Results: Of 2871 patients approached, 1020 (35.5%) completed the survey. Patients had high levels of concern about developing HCC and high levels of knowledge about HCC. However, patients had knowledge deficits, including believing surveillance was unnecessary when physical examination and laboratory results were normal. Nearly half of patients reported barriers to surveillance, including costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%). 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. Semi-annual HCC surveillance (vs none) was significantly associated with receipt of hepatology subspecialty care (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). Patterns of associations comparing annual vs no surveillance were similar although the magnitude of effects were reduced.

Conclusions: 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.

Keywords: Barriers; Early Detection; Knowledge; Liver Cancer; Screening.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Dr. Singal has served as a consultant for Wako Diagnostics, Glycotest, Exact Sciences, Roche, GRAIL, Bayer, and TARGET Pharmasolutions. None of the other authors have any relevant conflicts of interest to disclose

Figures

Figure 1:
Figure 1:
Patient Knowledge regarding HCC Surveillance, stratified by site
Figure 2:
Figure 2:
Patient Reported Barriers to HCC Surveillance, stratified by site
See this image and copyright information in PMC

References

    1. Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin Gastroenterol Hepatol 2019. - PMC - PubMed
    1. Kulik L, El-Serag HB. Epidemiology and Management of Hepatocellular Carcinoma. Gastroenterology 2019;156:477–491 e1. - PMC - PubMed
    1. Choi DT, Kum HC, Park S, et al. Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis. Clin Gastroenterol Hepatol 2019;17:976–987 e4. - PMC - PubMed
    1. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med 2014;11:e1001624. - PMC - PubMed
    1. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69:182–236. - PubMed

Publication types

MeSH terms