Multicenter Randomized Clinical Trial of a Mailed Outreach Strategy for Hepatocellular Carcinoma Surveillance

Singal, Amit G.; Reddy, Sarah; Patel, Himani; Villarreal, Deyaun L.; Khan, Aamir Z.; Liu, Yan; Cerda, Vanessa; Rich, Nicole E.; Murphy, Caitlin C.; Tiro, Jasmin A.; Kramer, Jennifer R.; Hernáez, Rubén

doi:10.1016/j.cgh.2021.12.014

Cited by 34 publications

(15 citation statements)

References 32 publications

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“…Several models of organized surveillance programs have been proposed to improve surveillance implementation. Outreach efforts using mailed surveillance invitations as well as “in-reach” efforts, such as electronic medical record reminders and provider education, have been shown to significantly improve surveillance utilization 91,94,95 . The AASLD recommends use of these evidence-based interventions to increase surveillance utilization in clinical practice.…”

Section: Surveillancementioning

confidence: 99%

AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma

et al. 2023

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Increasing AFP represents doubling of AFP, increase on two consecutive tests, or ≥ 20 ng/ml. 2 Can return to US q6 months if lesion stable on two exams. 3 CT/MRI may be preferred particularly in patients with obesity, alcohol or NASH-related cirrhosis, or Child Pugh class B or C cirrhosis. 4 Significantly elevated AFP: although no clear threshold has been established, AFP ≥ 200 ng/ml or ≥ 400 ng/ml may be considered significant elevations depending on clinical context. 5 Can perform chest and pelvic imaging in addition to alternative modality. If these are negative, other workup, including PET, can be considered.1930

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Section: Surveillancementioning

confidence: 99%

AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma

et al. 2023

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“…Surveillance adherence can be improved through a variety of interventions including patient or provider education, electronic medical record reminder systems, automated recall systems via radiology, or population health programs using mailed outreach. (83)(84)(85)(86)(87) Most studies suggest similar efficacy of interventions across patient subgroups, including liver disease etiology, although few have performed rigorous moderator analyses. SUMMARY: HCC surveillance is underused in clinical practice, including in patients with NAFLD, related to patient and provider-reported barriers.…”

Section: Surveillance Underusementioning

confidence: 99%

Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease

2023

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“…An intention-to-screen RCT with 1436 patients assigned to both a mailed HCC surveillance outreach arm and a visit-based surveillance arm over a 12-month period, demonstrated that the mailed outreach arm had higher semiannual surveillance rates (35.1% vs 21.9%) but clinical difference in proportion with early-stage HCC detection were seen in either arm. [77] Electronic medical record with clinical reminders (e-triggers) for HCC surveillance has also shown to improve surveillance underuse (18.2% to 27.6%) in VA cohort of patients with cirrhosis. [78] Although mailed outreach and e-triggers were associated an increase in surveillance rates, the latter remained dismally low and further implementation strategies need to be developed and tested.…”

Section: Opportunities Aheadmentioning

confidence: 99%

Current Challenges and Future Direction in Surveillance for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease

Cholankeril

El–Serag

2022

Semin Liver Dis

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The burden for hepatocellular carcinoma (HCC) attributed to nonalcoholic fatty liver disease (NAFLD) continues to grow in parallel with rising global trends in obesity. The risk of HCC is elevated among patients with NAFLD-related cirrhosis to a level that justify surveillance based on cost-effectiveness argument. The quality of current evidence for HCC surveillance in all patients with chronic liver disease is poor, and even lower in those with NAFLD. For a lack of more precise risk-stratification tools, current approaches to defining a target population in non-cirrhotic NAFLD are limited to noninvasive tests for liver fibrosis, as a proxy for liver-related morbidity and mortality. Beyond etiology and severity of liver disease, traditional and metabolic risk factors, such as diabetes mellitus, older age, male gender and tobacco smoking, are not enough for HCC risk stratification for surveillance efficacy and effectiveness in NAFLD. There is an association between molecular and genetic factors and HCC risk in NAFLD, and risk models integrating both clinical and genetic factors will be key to personalizing HCC risk. Herein in this review, we discuss concerns regarding defining a target population, surveillance test accuracy, surveillance underuse, and other cost-effective considerations for HCC surveillance in individuals with NAFLD.

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Multicenter Randomized Clinical Trial of a Mailed Outreach Strategy for Hepatocellular Carcinoma Surveillance

Cited by 34 publications

References 32 publications

AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma

AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma

Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease

Current Challenges and Future Direction in Surveillance for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease

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