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Interventions to Improve Surveillance for Hepatocellular Carcinoma in High-Risk Patients: A Scoping Review

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Abstract

Purpose

Hepatocellular carcinoma (HCC) is most often a sequela of chronic liver disease or chronic hepatitis B infection. Among high-risk patients, surveillance for HCC every 6 months is recommended by international guidelines. However, rates of HCC surveillance are suboptimal (11–64%). Barriers at the patient, provider, and healthcare delivery system levels have been identified.

Methods

We performed a systemic scoping review to identify and characterize interventions to improve HCC surveillance that has previously been evaluated. Searches using key terms in PubMed and Embase were performed to identify studies examining interventions designed to improve the surveillance rate for HCC in patients with cirrhosis or chronic liver disease that were published in English between January 1990 and September 2021.

Results

Included studies (14) had the following study designs: (1) randomized clinical trials (3, 21.4%), (2) quasi-experimental (2, 14.3%), (3) prospective cohort (6, 42.8%), and (4) retrospective cohort (3, 21.4%). Interventions included mailed outreach invitations, nursing outreach, patient education with or without printed materials, provider education, patient navigation, chronic disease management programs, nursing-led protocols for image ordering, automated reminders to physicians and nurses, web-based clinical management tools, HCC surveillance databases, provider compliance reports, radiology-led surveillance programs, subsidized HCC surveillance, and the use of oral medications. It was found that HCC surveillance rates increased after intervention implementation in all studies.

Conclusion

Despite improvements in HCC surveillance rates with intervention, compliance remained suboptimal. Further analysis of which interventions yield the greatest increases in HCC surveillance, design of multi-pronged strategies, and improved implementation are needed.

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Abbreviations

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

AASLD:

American Association for the Study of Liver Diseases

EASL-EORTC:

European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer

APASL:

Asian Pacific Association for the Study of the Liver

NCCN:

National Comprehensive Cancer Network (NCCN)

US:

Ultrasound

AFP:

Alpha-fetoprotein

UK:

United Kingdom

NCSP:

National Cancer Screening Program

USPSTF:

United States Preventive Services Task Force

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Author information

Authors and Affiliations

  1. Departments of Surgery and Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, Mailcode: HW04HO, Detroit, MI, 48201, USA

    Eliza W. Beal

  2. The Ohio State University College of Medicine, Columbus, OH, 43210, USA

    Molly McNamara & Mackenzie Owen

  3. The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH, 43210, USA

    Ann Scheck McAlearney

  4. Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA

    Ann Scheck McAlearney

  5. Department of Surgery, Division of Surgical Oncology, University of Virginia, Charlottsville, VA, 22908, USA

    Allan Tsung

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Contributions

All authors contributed to the study conception and design. Literature review, data collection, and analysis were performed by Molly McNamara and Eliza Beal. The first draft of the manuscript was written by Molly McNamara, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Eliza W. Beal.

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Appendix

Appendix

Table 3 Search strategies PubMed and Embase
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Beal, E.W., McNamara, M., Owen, M. et al. Interventions to Improve Surveillance for Hepatocellular Carcinoma in High-Risk Patients: A Scoping Review. J Gastrointest Canc 55, 1–14 (2024). https://doi.org/10.1007/s12029-023-00944-1

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