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Hepatocellular Carcinoma Screening Practices in the Department of Veterans Affairs: Findings from a National Facility Survey

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Abstract

Background

Previous studies suggest low rates of hepatocellular carcinoma (HCC) screening in clinical practice. There is little information on the provider- and healthcare-facility-related factors that explain the use of HCC screening.

Aims

We used data from the 2007 Survey to Assess Hepatitis C Care in Veterans Health Administration that collected information regarding the care of patients with hepatitis C virus (HCV) from 138 of 140 Veterans Administration healthcare facilities nationwide.

Methods

All providers caring for veterans with HCV were invited to respond. In addition, each facility was asked to identify a lead HCV clinician to respond to facility-specific questions. Our outcome was a response concordant with HCC screening guidelines [HCC screening in patients with cirrhosis or in patients with chronic hepatitis B virus (HBV), and screening every 6 or 12 months].

Results

A total of 268 providers responded (98 % facility participation rate). Of these, 190 respondents (70.9 %) reported recommending HCC screening with guideline-concordant risk groups and frequency. Providers reporting guideline-concordant HCC screening practices were significantly more likely to have expertise in liver disease (MD, gastroenterologists or hepatologists), routinely screen for varices, prescribe HCV treatment, and refer or manage patients with liver transplant. The availability of HCC-specific treatments on site was the main facility factor associated with guideline-concordant HCC screening.

Conclusions

Self-reported rates of guideline-concordant HCC screening are considerably higher than those seen in routine VA practice. Provider expertise in liver disease and the perceived availability of HCC treatment including transplantation in the local facility are important factors driving self-reported HCC screening practices.

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Acknowledgments

This work is funded in part by NIH grant R01 CA125487 and in part by the Houston VA HSR&D Center of Excellence (HFP90-020).

Conflict of interest

None.

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Authors

Corresponding author

Correspondence to Hashem B. El-Serag.

Appendices

Appendix 1: The Two Survey Questions from the Survey to Assess Hepatitis C Care in Veterans Health Administration That Were Used in This Study to Define the Two Outcomes of Interest

Which patients do you recommend for hepatocellular carcinoma (HCC) screening at your facility/(check all that apply)

 All patients with chronic hepatitis C infection

 Patients with chronic HBV infection

 Patients with cirrhosis

 Other patient groups (please specify)

Patients with high risk for hepatocellular carcinoma (HCC) are screened every

 3 months

 6 months

 12 months

 Don’t screen

 Other (please specify)

Appendix 2: The Questions Used in the Current Analysis

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figure b

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El-Serag, H.B., Alsarraj, A., Richardson, P. et al. Hepatocellular Carcinoma Screening Practices in the Department of Veterans Affairs: Findings from a National Facility Survey. Dig Dis Sci 58, 3117–3126 (2013). https://doi.org/10.1007/s10620-013-2794-7

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  • DOI: https://doi.org/10.1007/s10620-013-2794-7

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