Statewide Survey of Primary Care and Subspecialty Providers on Hepatocellular Carcinoma Risk-Stratification and Surveillance Practices

• Published in: Digestive diseases and sciences 2024-07, Vol.69 (7), p.2437-2449
• Main Authors: Moon, Andrew M., Swier, Rachel M., Lane, Lindsay M., Barritt, A. Sidney, Sanoff, Hanna K., Olshan, Andrew F., Wheeler, Stephanie B., Ioannou, George N., Kim, Nicole J., Hagan, Scott, Vutien, Philip, Benefield, Thad, Henderson, Louise M.
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Biochemistry; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - therapy; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Female; Gastroenterology; Gastroenterology - statistics & numerical data; Health Care Surveys; Hepatitis C; Hepatology; Humans; Liver cancer; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Neoplasms - diagnosis; Liver Neoplasms - epidemiology; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; North Carolina - epidemiology; Oncology; Original Article; Practice Patterns, Physicians' - statistics & numerical data; Primary care; Primary Health Care - statistics & numerical data; Risk Assessment; Surveillance; Surveys and Questionnaires; Transplant Surgery
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-024-08442-5

Background Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with improved survival. Provision of HCC surveillance is low in the US, particularly in primary care settings. Aims To evaluate current hepatitis C virus (HCV) and HCC surveillance practices and physician attitudes regarding HCC risk-stratification among primary care and subspecialty providers. Methods Using the Tailored Design Method, we delivered a 34-item online survey to 7654 North Carolina-licensed internal/family medicine or gastroenterology/hepatology physicians and advanced practice providers in 2022. We included the domains of HCV treatment, cirrhosis diagnosis, HCC surveillance practices, barriers to surveillance, and interest in risk-stratification tools. We performed descriptive analyses to summarize responses. Tabulations were weighted based on sampling weights accounting for non-response and inter-specialty comparisons were made using chi-squared or t test statistics. Results After exclusions, 266 responses were included in the final sample (response rate 3.8%). Most respondents (78%) diagnosed cirrhosis using imaging and a minority used non-invasive tests that were blood-based (~ 15%) or transient elastography (31%). Compared to primary care providers, subspecialists were more likely to perform HCC surveillance every 6-months (vs annual) (98% vs 35%, p   70%) expressed interest in potential solutions to improve HCC risk-stratification. Conclusions In this statewide survey, there were great knowledge gaps in HCC surveillance among PCPs and most respondents expressed interest in strategies to increase appropriate HCC surveillance.