Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis

Authors

Amit G Singal
Jasmin A Tiro
Caitlin C Murphy
James-Michael Blackwell
Jennifer R Kramer
Aisha Khan
Yan Liu
Song Zhang
Jessica L Phillips
Ruben Hernaez

Publication Date

5-1-2021

Journal

Clinical Gastroenterology and Hepatology

DOI

10.1016/j.cgh.2020.06.049

PMID

32629122

PMCID

PMC7779689

PubMedCentral® Posted Date

5-1-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Carcinoma, Hepatocellular, Early Detection of Cancer, Humans, Liver Cirrhosis, Liver Neoplasms, Patient Reported Outcome Measures, liver cancer, screening, knowledge, barriers, early detection

Abstract

BACKGROUND: More than 20% of patients with cirrhosis do not receive semi-annual hepatocellular carcinoma (HCC) surveillance as recommended. Few studies have evaluated the effects of patient-level factors on surveillance receipt.

METHODS: We administered a telephone survey to a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) to characterize patient knowledge, attitudes, and perceived barriers of HCC surveillance. Multinomial logistic regression was performed to identify factors associated with HCC surveillance receipt (semi-annual and annual vs none) during the 12-month period preceding survey administration.

RESULTS: Of 2871 patients approached, 1020 (35.5%) completed the survey. Patients had high levels of concern about developing HCC and high levels of knowledge about HCC. However, patients had knowledge deficits, including believing surveillance was unnecessary when physical examination and laboratory results were normal. Nearly half of patients reported barriers to surveillance, including costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%). In the year before the survey, 745 patients (73.1%) received 1 or more surveillance examination; 281 received on-schedule, semi-annual surveillance and 464 received annual surveillance. Semi-annual HCC surveillance (vs none) was significantly associated with receipt of hepatology subspecialty care (odds ratio, 30.1; 95% CI, 17.5-51.8) and inversely associated with patient-reported barriers (odds ratio, 0.62; 95% CI, 0.41-0.94). Patterns of associations comparing annual vs no surveillance were similar although the magnitude of effects were reduced.

CONCLUSIONS: Patient-reported barriers such as knowledge deficits, costs, difficulty scheduling, and transportation are significantly associated with less frequent receipt of HCC surveillance, indicating a need for patient-centered interventions, such as patient navigation.

Comments

Associated Data