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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Kim, NJ; Rozenberg-Ben-Dror, K; Jacob, DA; Rich, NE; Singal, AG; Aby, ES; Yang, JD; Nguyen, V; Pillai, A; Fuchs, M; Moon, AM; Shroff, H; Agarwal, PD; Perumalswami, P; Chandna, S; Zhou, K; Patel, YA; Latt, NL; Wong, R; Duarte-Rojo, A; Lindenmeyer, CC; Frenette, C; Ge, J; Mehta, N; Yao, F; Benhammou, JN; Bloom, PP; Leise, M; Kim, H-S; Levy, C; Barnard, A; Khalili, M; Ioannou, GN

Published Date

  • January 2022

Published In

Volume / Issue

  • 20 / 1

Start / End Page

  • 183 - 193

PubMed ID

  • 32927050

Pubmed Central ID

  • PMC8657369

Electronic International Standard Serial Number (EISSN)

  • 1542-7714

Digital Object Identifier (DOI)

  • 10.1016/j.cgh.2020.09.015


  • eng

Conference Location

  • United States