Statewide Survey of Primary Care and Subspecialty Providers on Hepatocellular Carcinoma Risk-Stratification and Surveillance Practices

Andrew M Moon^{1

2

3}, Rachel M Swier⁴, Lindsay M Lane⁵, A Sidney Barritt 4th^{6

7}, Hanna K Sanoff^{8

9}, Andrew F Olshan¹⁰, Stephanie B Wheeler^{8

11}, George N Ioannou^{12

13}, Nicole J Kim¹³, Scott Hagan¹⁴, Philip Vutien¹³, Thad Benefield⁵, Louise M Henderson^{8

5

10}

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.
² UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA. Andrew.Moon@unchealth.unc.edu.
³ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.
⁴ Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁵ Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA.
⁸ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
⁹ Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁰ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹² Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
¹³ Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA.
¹⁴ Division of General Internal Medicine, University of Washington, VA Puget Sound Healthcare System, Seattle, USA.

PMID: 38652392
DOI: 10.1007/s10620-024-08442-5

Statewide Survey of Primary Care and Subspecialty Providers on Hepatocellular Carcinoma Risk-Stratification and Surveillance Practices

Andrew M Moon et al. Dig Dis Sci. 2024 Jul.

. 2024 Jul;69(7):2437-2449.

doi: 10.1007/s10620-024-08442-5. Epub 2024 Apr 23.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.
² UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA. Andrew.Moon@unchealth.unc.edu.
³ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. Andrew.Moon@unchealth.unc.edu.
⁴ Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁵ Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ UNC Liver Center, University of North Carolina at Chapel Hill School of Medicine, 8009 Burnett Womack Bldg, CB#7584, Chapel Hill, NC, 27599-7584, USA.
⁸ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
⁹ Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁰ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹² Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
¹³ Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA.
¹⁴ Division of General Internal Medicine, University of Washington, VA Puget Sound Healthcare System, Seattle, USA.

PMID: 38652392
DOI: 10.1007/s10620-024-08442-5

Abstract

Background: Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with improved survival. Provision of HCC surveillance is low in the US, particularly in primary care settings.

Aims: To evaluate current hepatitis C virus (HCV) and HCC surveillance practices and physician attitudes regarding HCC risk-stratification among primary care and subspecialty providers.

Methods: Using the Tailored Design Method, we delivered a 34-item online survey to 7654 North Carolina-licensed internal/family medicine or gastroenterology/hepatology physicians and advanced practice providers in 2022. We included the domains of HCV treatment, cirrhosis diagnosis, HCC surveillance practices, barriers to surveillance, and interest in risk-stratification tools. We performed descriptive analyses to summarize responses. Tabulations were weighted based on sampling weights accounting for non-response and inter-specialty comparisons were made using chi-squared or t test statistics.

Results: After exclusions, 266 responses were included in the final sample (response rate 3.8%). Most respondents (78%) diagnosed cirrhosis using imaging and a minority used non-invasive tests that were blood-based (~ 15%) or transient elastography (31%). Compared to primary care providers, subspecialists were more likely to perform HCC surveillance every 6-months (vs annual) (98% vs 35%, p < 0.0001). Most respondents (80%) believed there were strong data to support HCC surveillance, but primary care providers did not know which liver disease patients needed surveillance. Most providers (> 70%) expressed interest in potential solutions to improve HCC risk-stratification.

Conclusions: In this statewide survey, there were great knowledge gaps in HCC surveillance among PCPs and most respondents expressed interest in strategies to increase appropriate HCC surveillance.

Keywords: Cirrhosis; Hepatitis C; Liver cancer; Screening.

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References

1. Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin Gastroenterol Hepatol. 2020;18:2650–2666. - DOI - PubMed
1. Rahib L, Wehner MR, Matrisian LM, Nead KT. Estimated Projection of US Cancer Incidence and Death to 2040. JAMA Netw Open. 2021;4:e214708. - DOI - PubMed - PMC
1. Singal AG, Zhang E, Narasimman M et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022;77:128–139. - DOI - PubMed - PMC
1. Singal AG, Llovet JM, Yarchoan M et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023.
1. Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis: A Systematic Review and Meta-Analysis. Hepatology. 2021;73:713–725. - DOI - PubMed

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Statewide Survey of Primary Care and Subspecialty Providers on Hepatocellular Carcinoma Risk-Stratification and Surveillance Practices

Affiliations

Statewide Survey of Primary Care and Subspecialty Providers on Hepatocellular Carcinoma Risk-Stratification and Surveillance Practices

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical