Controlling liver cancer internationally: A qualitative study of clinicians' perceptions of current public policy needs

Abstract

BackgroundLiver cancer is the fifth most common cancer in men and the seventh for women. Usually because of late diagnosis, the prognosis for liver cancer remains poor, resulting in liver cancer being the third most common cause of death from cancer. While some countries have treatment guidelines, little is known or understood about the strategies needed for liver cancer control internationally.ObjectiveTo explore leading liver cancer clinician's perceptions of the current public policy needs to control liver cancer internationally.MethodsKey informant interviews were conducted with a range of liver cancer clinicians involved in policy in eleven countries. Interviews were digitally recorded, transcribed verbatim, translated (where necessary), de-identified and analyzed by two researchers using a constant comparative method.ResultsTwenty in-depth semi-structured interviews were conducted in: Australia, China, France, Germany, Italy, Japan, Spain, South Korea, Taiwan, Turkey and the United States. Nine themes were identified and cluster into three groups: 1) Promoting prevention via early risk assessment, focusing on viral hepatitis and other lifestyle factors; 2) Increasing political, public and medical community awareness; and 3) Improving funding for screening, liver cancer surveillance and treatment.ConclusionThis study is an important step towards developing an evidence-based approach to assessing preparedness for implementing comprehensive liver cancer control strategies. Evaluation mechanisms to assess countries' performance on the needs described are needed. Future research will concentrate of understanding how these needs vary across countries and the optimal strategies to improve the diagnosis and prognosis of patients with liver cancer internationally.

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“…A comprehensive risk assessment and referral program in Japan has been successful (Song et al 2010) but European countries have not introduced similar programs and have been slow to introduce testing methods that are common in Japan (Sherman 2005). Greater political awareness may be a necessary prerequisite for a coordinated policy approach, while at the patient level, more advocacy and education may be necessary to ensure people understand the risks and options available for identifying and treating liver disease (Bridges et al 2011a). …”