Language
English
Publication Date
11-11-2024
Journal
Gut
DOI
10.1136/gutjnl-2024-332508
PMID
38839269
PMCID
PMC11560624
PubMedCentral® Posted Date
11-11-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
Background: Hepatocellular carcinoma (HCC) is plagued by failures across the cancer care continuum, leading to frequent late-stage diagnoses and high mortality. We evaluated the effectiveness of mailed outreach invitations plus patient navigation to promote HCC screening process completion in patients with cirrhosis.
Methods: Between April 2018 and September 2021, we conducted a multicentre pragmatic randomised clinical trial comparing mailed outreach plus patient navigation for HCC screening (n=1436) versus usual care with visit-based screening (n=1436) among patients with cirrhosis at three US health systems. Our primary outcome was screening process completion over a 36-month period, and our secondary outcome was the proportion of time covered (PTC) by screening. All patients were included in intention-to-screen analyses.
Results: All 2872 participants (median age 61.3 years; 32.3% women) were included in intention-to-screen analyses. Screening process completion was observed in 6.6% (95% CI: 5.3% to 7.9%) of patients randomised to outreach and 3.3% (95% CI: 2.4% to 4.3%) of those randomised to usual care (OR 2.05, 95% CI: 1.44 to 2.92). The intervention increased HCC screening process completion across most subgroups including age, sex, race and ethnicity, Child-Turcotte-Pugh class and health system. PTC was also significantly higher in the outreach arm than usual care (mean 37.5% vs 28.2%; RR 1.33, 95% CI: 1.31 to 1.35). Despite screening underuse, most HCC in both arms were detected at an early stage.
Conclusion: Mailed outreach plus navigation significantly increased HCC screening process completion versus usual care in patients with cirrhosis, with a consistent effect across most examined subgroups. However, screening completion remained suboptimal in both arms, underscoring a need for more intensive interventions.
Keywords
Aged, Female, Humans, Male, Middle Aged, Carcinoma, Hepatocellular, Early Detection of Cancer, Liver Cirrhosis, Liver Neoplasms, Patient Navigation, Postal Service, screening, liver cancer, cirrhosis, mailed outreach, patient navigation
Published Open-Access
yes
Recommended Citation
Singal, Amit G; Narasimman, Manasa; Daher, Darine; et al., "Effectiveness of Mailed Outreach and Patient Navigation to Promote Hcc Screening Process Completion: A Multicentre Pragmatic Randomised Clinical Trial" (2024). Faculty and Staff Publications. 4567.
https://digitalcommons.library.tmc.edu/baylor_docs/4567
Comments
Trial registration number: NCT02582918.