Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States.

Autor:	Kim NJ; Division of Gastroenterology, University of Washington, Seattle, Washington. Electronic address: nkim8@medicine.washington.edu., Rozenberg-Ben-Dror K; Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, Westchester, Illinois., Jacob DA; Veteran Affairs Heart of Texas Health Care Network, VISN 17 PBM, Temple, Texas., Rich NE; Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas., Singal AG; Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas., Aby ES; Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota., Yang JD; Division of Digestive and Liver Diseases, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California., Nguyen V; Division of Gastroenterology, University of Arizona, Tucson, Arizona., Pillai A; Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois., Fuchs M; Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Hepatology Section, Central Virginia Veteran Affairs Health Care System, Richmond, Virginia., Moon AM; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina., Shroff H; Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois., Agarwal PD; Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Perumalswami P; Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York., Chandna S; Division of Gastroenterology, Hepatology, and Nutrition, University of Utah, Salt Lake City, Utah., Zhou K; Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California., Patel YA; Division of Gastroenterology, Duke University, Durham, North Carolina., Latt NL; Ochsner Multi-Organ Transplant Institute, Division of Gastroenterology, Ochsner Health, New Orleans, Louisiana., Wong R; Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California., Duarte-Rojo A; Division of Gastroenterology, University of Pittsburgh, Pittsburgh, Pennsylvania., Lindenmeyer CC; Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio., Frenette C; Division of Organ Transplantation, Scripps Green Hospital, La Jolla, California., Ge J; Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California., Mehta N; Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California., Yao F; Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California., Benhammou JN; Division of Gastroenterology, University of California Los Angeles, Los Angeles, California., Bloom PP; Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts., Leise M; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota., Kim HS; Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas., Levy C; Division of Gastroenterology and Hepatology, University of Miami, Miami, Florida., Barnard A; Division of Gastroenterology, University of California San Diego, La Jolla, California., Khalili M; Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California., Ioannou GN; Division of Gastroenterology, University of Washington, Seattle, Washington; Division of Gastroenterology, Veteran Affairs Puget Sound Health Care System, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2022 Jan; Vol. 20 (1), pp. 183-193. Date of Electronic Publication: 2020 Sep 12.
DOI:	10.1016/j.cgh.2020.09.015
Abstrakt:	Background & Aims: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers' opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient's HCC risk on the choice of surveillance modality. Methods: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states. Results: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient's HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001). Conclusions: Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients' estimated HCC risk, instead of our current "one-size-fits all" strategy. (Copyright © 2022 AGA Institute. All rights reserved.)
Databáze:	MEDLINE
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