Adherence to Screening for Hepatocellular Carcinoma Among Patients with Cirrhosis or Chronic Hepatitis B in a Community Setting

Wong, Carrie R.; Garcia, Ruel T.; Trinh, Huy N.; Lam, Khoa D.; Ha, Nghi B.; Nguyen, Huy; Nguyen, Khanh K.; Levitt, Brian S.; Nguyen, Mindie H.

doi:10.1007/s10620-009-1015-x

Cited by 59 publications

(74 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Searches of annual meeting abstracts yielded two relevant abstracts; sufficient data for inclusion were obtained for both abstracts after contacting the authors. Finally, recursive literature searches identified one additional article that met inclusion criteria, producing a total of nine studies for inclusion in this meta-analysis [7][8][9][10][11][12][13][14][15] (Table 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…Four studies retrospectively assessed whether patients with HCC had surveillance prior to their diagnosis [8][9][10][11] and five studies retrospectively assessed surveillance among patients with a known diagnosis of cirrhosis. 7,[12][13][14][15] The surveillance rates between the two groups were not statistically different, 18.7% (95%CI 17.2-20.3%) and 18.4% (95%CI 17.8-19.0%), respectively.…”

Section: Surveillance Utilizationmentioning

confidence: 99%

“…There were a variety of definitions for surveillance among the nine studies, including differences in surveillance tests and surveillance intervals. Six of the studies determined surveillance rates via manual chart review, [9][10][11][13][14][15] whereas three studies used administrative data. 7,8,12 Only four studies assessed surveillance utilization every 6-12 months, 10,13-15 consistent with AASLD guidelines, whereas five studies used a less stringent definition of surveillance, such as less frequent intervals.…”

Section: Surveillance Utilizationmentioning

confidence: 99%

“…5 Although surveillance can be highly efficacious for detecting early HCC, 6 its effectiveness in clinical practice may be impacted by low utilization rates among at-risk patients. [7][8][9][10][11][12][13][14][15] HCC disproportionately affects disadvantaged populations, with the highest age-specific rates occurring among minorities. HCC rates are two times higher in Asian Americans than African Americans, whose rates are two times higher than those in Caucasians.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

et al. 2012

View full text Add to dashboard Cite

BACKGROUND: Although surveillance for hepatocellular carcinoma (HCC) is recommended in high-risk patients, several studies have suggested it is being underutilized in clinical practice. The aim of our study was to quantify utilization rates for HCC surveillance among patients with cirrhosis and summarize patterns of association between utilization rates and patient socio-demographic characteristics. DATA SOURCES: We performed a systematic literature review using the Medline database from January 1990 through March 2011 and a manual search of national meeting abstracts from 2008-2010. METHODS: Two investigators independently extracted data on patient populations, study methods, and results using standardized forms. A pooled surveillance rate with 95% confidence intervals was calculated. Prespecified subgroup analysis was performed to find correlates of surveillance utilization. RESULTS: We identified nine studies that met inclusion criteria. The pooled surveillance rate was 18.4% (95%CI 17.8%-19.0%). Surveillance rates were significantly higher among patients followed in subspecialty gastroenterology clinics compared to those followed in primary care clinics (51.7% vs. 16.9%, p<0.001). NonCaucasians and patients of low socioeconomic status had lower surveillance rates than their counterparts. CONCLUSIONS: Utilization rates for HCC surveillance are low, although they are significantly higher among patients followed in subspecialty clinics. Current studies fail to determine why HCC surveillance is not being performed. Future efforts should focus on identifying appropriate intervention targets to increase surveillance rates and reduce socio-demographic disparities.

show abstract

Section: Literature Searchmentioning

confidence: 99%

Section: Surveillance Utilizationmentioning

confidence: 99%

Section: Surveillance Utilizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

et al. 2012

View full text Add to dashboard Cite

show abstract

“…(11) Similar patterns have been recognized in the community setting, where a minority of HBV patients, including those with cirrhosis, had low rates of antiviral therapy initiation and HCC screening. (12) However, no published US studies to date have examined HBV care quality among a national sample.…”

mentioning

confidence: 99%

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

et al. 2016

View full text Add to dashboard Cite

Previous studies have identified gaps in hepatitis B care. The objectives of this study were to evaluate the delivery of care among a national cohort of US veterans with chronic hepatitis B infection and examine risk factors for adverse clinical outcomes. We conducted a retrospective cohort study using the Veterans Health Administration Corporate Data Warehouse from 1999 to 2013 to evaluate (1) care delivery and (2) clinical outcomes such as hepatocellular carcinoma, hepatic decompensation, and mortality among US veterans with hepatitis B. Incidence rates with 95% confidence intervals were calculated and Cox regression models were used to evaluate clinical outcomes. We identified 21,419 veterans with a positive hepatitis B surface antigen, and 97% of patients had alanine aminotransferase and 44% had hepatitis B virus DNA testing; hepatitis B e antigen and hepatitis B e antibody were tested <50% of the time. Patients receiving specialty care had a higher prevalence of recommended laboratory testing. Patients with elevated alanine aminotransferase in specialty care were more likely to receive antiviral therapy (50% versus 24% for specialty care versus no specialty care, P < 0.001). Among patients with cirrhosis, 69% received one-time liver imaging. The proportion of follow-up time adherent to annual imaging was 0.39 (standard deviation 5 0.42), and the proportion was 0.28 (standard deviation 5 0.33) for biannual imaging; both proportions were higher in the specialty care group (all P < 0.05). Antiviral therapy (hazard ratio 5 0.85, 95% confidence interval 0.76-0.95, P 5 0.005) and liver imaging (hazard ratio 5 0.84, 95% confidence interval 0.76-0.91, P < 0.001) were independently associated with decreased mortality in adjusted analyses. Conclusion: We observed a low prevalence of recommended laboratory testing, antiviral therapy initiation, and liver imaging among a national cohort of veterans with hepatitis B infection; antiviral therapy and liver imaging were independently associated with decreased mortality. (HEPATOLOGY 2016;63:1774-1782 SEE EDITORIAL ON PAGE 1755A pproximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV). In the United States, the prevalence of chronic hepatitis B remains incompletely quantified, with estimates ranging from approximately 800,000 individuals to as high as 2.2 million when including foreign-born Americans. (1,2) Chronic HBV infection is a significant cause of morbidity and mortality, leading to liver failure, cirrhosis, and hepatocellular carcinoma (HCC) in 25%-40% of infected persons. (3) Specifically, in the United States, hepatitis B is the underlying cause of an estimated 1800-4000 deaths each year. (2,4) Despite the significant burden of disease and existence of management guidelines for the evaluation and treatment of chronic HBV, (5) studies have shown variable adherence to recommended HBV care, including low rates of alanine aminotransferase (ALT) and HBV DNA level monitoring and infrequent HCC surveillance. (6,7) Significant gaps i...

show abstract

Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B

Aghoram

Cai

Dickinson

2012

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Adherence to Screening for Hepatocellular Carcinoma Among Patients with Cirrhosis or Chronic Hepatitis B in a Community Setting

Abstract: Since more frequent clinic visits is a strong independent predictor of improved screening adherence, regular routine clinic visits may help improve adherence to HCC screening, which may also lead to improved clinical outcomes.

Cited by 59 publications

References 24 publications

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B

Contact Info

Product

Resources

About