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

Singal, Amit G.; Yopp, Adam C.; Skinner, Celette Sugg; Packer, Milton; Lee, William M.; Tiro, Jasmin A.

doi:10.1007/s11606-011-1952-x

Cited by 249 publications

(241 citation statements)

References 26 publications

Supporting

Mentioning

224

Contrasting

Unclassified

Order By: Relevance

“…29 However, underutilization of HCC surveillance is common with most studies reporting rates below 30%. 30 Similar situation may also occur in kidney transplant recipients. In our cohort, only 4 out of the 20 patients diagnosed with HCC received USG surveillance at intervals between 6 and 12 months.…”

Section: Discussionmentioning

confidence: 82%

Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

et al. 2014

View full text Add to dashboard Cite

Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.

show abstract

Section: Discussionmentioning

confidence: 82%

Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Several cohort studies have demonstrated that HCC surveillance is associated with higher rates of early tumor detection, curative treatment receipt, and overall survival (6) ; however, fewer than 20% of patients with cirrhosis in the United States undergo HCC surveillance. (7) HCC surveillance rates are even lower among racial-ethnic minorities and patients of low socioeconomic status (SES), likely related to a combination of medical, socioeconomic, and cultural issues. (8) Although provider recommendation is reported to be a strong predictor for HCC surveillance, (9) patient-level factors may also play an important role in surveillance underuse.…”

Section: Conclusion-patientsmentioning

confidence: 99%

“…(12,13) However, most studies evaluating HCC surveillance correlates have primarily focused on patient sociodemographic and clinical characteristics. (7,14) The effect of theory-based, patient-reported psychosocial factors on HCC surveillance completion has not been quantified. A better understanding of patient knowledge, attitudes, and barriers, particularly among low-income minorities, is crucial to develop and implement effective interventions to improve HCC surveillance rates.…”

mentioning

confidence: 99%

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Farvardin

Patel

Khambaty³

et al. 2016

Hepatology

Self Cite

149

130

View full text Add to dashboard Cite

Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO: Amit G. Singal, M.D., M.S., Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5959 Harry Hines Boulevard, POB 1, Suite 420, amit.singal@utsouthwestern.edu,. * These authors contributed equally to this work and are co-first authors.Potential conflict of interest: Dr. Singal consults for and is on the speakers' bureau for Bayer. Dr. Yopp is on the speakers' bureau for Bayer and received grants from Novartis and Peregrine.Author names in bold designate shared co-first Although provider recommendation is reported to be a strong predictor for HCC surveillance, (9) patient-level factors may also play an important role in surveillance underuse. In prospective cohort studies, nearly 1 in 5 patients were nonadherent with provider recommendations for HCC surveillance. (10,11) The cancer-screening literature has applied theoretical models of behavior change and demonstrated that patients' poor knowledge, negative attitudes, or perceived barriers to cancer screening may be associated with lower screening rates. (12,13) However, most studies evaluating HCC surveillance correlates have primarily focused on patient sociodemographic and clinical characteristics. (7,14) The effect of theory-based, patient-reported psychosocial factors on HCC surveillance completion has not been quantified. A better understanding of patient knowledge, attitudes, and barriers, particularly among low-income minorities, i...

show abstract

“…Similarly, among patients in the national VA Hepatitis C Clinical Case Registry, black patients were less likely than any other racial group to undergo routine surveillance (OR 0.6, 95% CI=0.45-0.81) defined as either AFP or ultrasound in two consecutive years within the first four years after diagnosis of cirrhosis [41].…”

Section: Lower Hcc Surveillance Rates In African Americansmentioning

confidence: 99%

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Ad¹

2017

Austin J Gastroenterol

View full text Add to dashboard Cite

Liver cancer remains an important cause of cancer mortality in the United States. Incidence of hepatocellular carcinoma (HCC), the most common histological cell type of liver cancer, has increased over the past 30 years. The statistics are particularly worrisome for African Americans. Their incidence of HCC far surpasses that of other races, particularly whites. Additionally, mortality for African Americans with HCC is also far worse. In a review of the literature, we found a stepwise progression of variables that may contribute to this observation. African Americans have the highest observed rates of infection with chronic hepatitis and are offered treatment less often for hepatitis C virus. The progression to cirrhosis is slower, which may complicate HCC surveillance. Regardless, they receive surveillance either biochemical or radiographic at a lower rate than patients of other races. Further, African Americans present at a more advanced stage and are referred for curative therapy less often. When African Americans do receive therapy, their outcomes are worse. Additional investigation is warranted as to whether differences in tumor biology may also play a role.

show abstract

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

Cited by 249 publications

References 26 publications

Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Contact Info

Product

Resources

About