Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States

Nicole J Kim; Karine Rozenberg-Ben-Dror; David A Jacob; Nicole Rich; Amit G Singal; Elizabeth S Aby; Ju Dong Yang; Veronica Nguyen; Anjana Pillai; Michael Fuchs; Andrew M Moon; Hersh Shroff; Parul D Agarwal; Ponni Perumalswami; Shaun Chandna; Kali Zhou; Yuval A Patel; Nyan L Latt; Robert Wong; Andres Duarte-Rojo; Christina C Lindenmeyer; Catherine Frenette; Jin Ge; Neil Mehta; Francis Yao; Jihane N Benhammou; Patricia P Bloom; Michael Leise; Hyun-seok Kim; Cynthia Levy; Abbey Barnard; Mandana Khalili; George N Ioannou

doi:10.1016/j.cgh.2020.09.015

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Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States

Journal article

Peer reviewed

Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States

Nicole J Kim, Karine Rozenberg-Ben-Dror, David A Jacob, Nicole Rich, Amit G Singal, Elizabeth S Aby, Ju Dong Yang, Veronica Nguyen, Anjana Pillai, Michael Fuchs, …

Clinical gastroenterology and hepatology

2020-09-12

DOI: https://doi.org/10.1016/j.cgh.2020.09.015

PMID: 32927050

Abstract

Screening

Magnetic Resonance Imaging

Liver Cancer

Computed Tomography

Ultrasound

Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers’ opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient’s HCC risk on the choice of surveillance modality. We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 U.S. medical centers in 17 states. Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient’s HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; p < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; p < .001). Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients’ estimated HCC risk, instead of our current “one-size-fits all” strategy. [Display omitted]

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.111 Liver & Colon Cancer; 1.111.162 Hepatocellular Carcinoma
Web Of Science research areas: Gastroenterology & Hepatology
ESI research areas: Clinical Medicine

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Details

Title: Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States
Creators: Nicole J Kim - Division of Gastroenterology, University of Washington, Seattle, Washington
Karine Rozenberg-Ben-Dror - Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, Westchester, Illinois
David A Jacob - Veteran Affairs Heart of Texas Health Care Network, VISN 17 PBM, Temple, Texas
Nicole Rich - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Amit G Singal - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Elizabeth S Aby - Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
Ju Dong Yang - Division of Digestive and Liver Diseases, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California
Veronica Nguyen - Division of Gastroenterology, University of Arizona, Tucson, Arizona
Anjana Pillai - Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
Michael Fuchs - Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Hepatology Section, Central Virginia Veteran Affairs Health Care System, Richmond, Virginia
Andrew M Moon - Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
Hersh Shroff - Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
Parul D Agarwal - Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Ponni Perumalswami - Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
Shaun Chandna - Division of Gastroenterology, Hepatology, and Nutrition, University of Utah, Salt Lake City, Utah
Kali Zhou - Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California
Yuval A Patel - Division of Gastroenterology, Duke University, Durham, North Carolina
Nyan L Latt - Ochsner Multi-Organ Transplant Institute, Division of Gastroenterology, Ochsner Health, New Orleans, Louisiana
Robert Wong - Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California
Andres Duarte-Rojo - Division of Gastroenterology, University of Pittsburgh, Pittsburgh, Pennsylvania
Christina C Lindenmeyer - Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
Catherine Frenette - Division of Organ Transplantation, Scripps Green Hospital, La Jolla, California
Jin Ge - Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
Neil Mehta - Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
Francis Yao - Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
Jihane N Benhammou - Division of Gastroenterology, University of California Los Angeles, Los Angeles, California
Patricia P Bloom - Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
Michael Leise - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Hyun-seok Kim - Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
Cynthia Levy - Division of Gastroenterology and Hepatology, University of Miami, Miami, Florida
Abbey Barnard - Division of Gastroenterology, University of California San Diego, La Jolla, California
Mandana Khalili - Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
George N Ioannou - Division of Gastroenterology, University of Washington, Seattle, Washington
Publication Details: Clinical gastroenterology and hepatology
Publisher: Elsevier Inc
Grant note: T32DK007742 / National Institutes of Health (https://doi.org/10.13039/100000002) UL1TR002319; KL2TR002317; TL1TR002318 / National Center for Advancing Translational Sciences (https://doi.org/10.13039/100006108) University of Washington (https://doi.org/10.13039/100007812) R01CA196692; I01CX001156 / National Cancer Institute (https://doi.org/10.13039/100000054) K24AA022523 / National Institute on Alcohol Abuse and Alcoholism (https://doi.org/10.13039/100000027) Institute of Translational Health Sciences (https://doi.org/10.13039/100013382)
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hepatology
Language: English
Resource Type: Journal article
PMID: 32927050
Record Identifier: 991031597635602976