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Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma.

Publication ,  Journal Article
Rich, NE; Yang, JD; Perumalswami, PV; Alkhouri, N; Jackson, W; Parikh, ND; Mehta, N; Salgia, R; Duarte-Rojo, A; Kulik, L; Rakoski, M; Said, A ...
Published in: Clin Gastroenterol Hepatol
April 2020

BACKGROUND & AIMS: Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. METHODS: We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). RESULTS: Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3-12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3-12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. CONCLUSIONS: Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.

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Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

April 2020

Volume

18

Issue

4

Start / End Page

974 / 983

Location

United States

Related Subject Headings

  • Neoplasm Recurrence, Local
  • Liver Neoplasms
  • Humans
  • Hepatitis C, Chronic
  • Gastroenterology & Hepatology
  • Chemoembolization, Therapeutic
  • Carcinoma, Hepatocellular
  • Attitude
  • Antiviral Agents
  • 3202 Clinical sciences
 

Citation

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Rich, N. E., Yang, J. D., Perumalswami, P. V., Alkhouri, N., Jackson, W., Parikh, N. D., … Singal, A. G. (2020). Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol, 18(4), 974–983. https://doi.org/10.1016/j.cgh.2019.07.042
Rich, Nicole E., Ju Dong Yang, Ponni V. Perumalswami, Naim Alkhouri, Whitney Jackson, Neehar D. Parikh, Neil Mehta, et al. “Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma.Clin Gastroenterol Hepatol 18, no. 4 (April 2020): 974–83. https://doi.org/10.1016/j.cgh.2019.07.042.
Rich NE, Yang JD, Perumalswami PV, Alkhouri N, Jackson W, Parikh ND, et al. Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Apr;18(4):974–83.
Rich, Nicole E., et al. “Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma.Clin Gastroenterol Hepatol, vol. 18, no. 4, Apr. 2020, pp. 974–83. Pubmed, doi:10.1016/j.cgh.2019.07.042.
Rich NE, Yang JD, Perumalswami PV, Alkhouri N, Jackson W, Parikh ND, Mehta N, Salgia R, Duarte-Rojo A, Kulik L, Rakoski M, Said A, Oloruntoba O, Ioannou GN, Hoteit MA, Moon AM, Rangnekar AS, Eswaran SL, Zheng E, Jou JH, Hanje J, Pillai A, Hernaez R, Wong R, Scaglione S, Samant H, Kapuria D, Chandna S, Rosenblatt R, Ajmera V, Frenette CT, Satapathy SK, Mantry P, Jalal P, John BV, Fix OK, Leise M, Lindenmeyer CC, Flores A, Patel N, Jiang ZG, Latt N, Dhanasekaran R, Odewole M, Kagan S, Marrero JA, Singal AG. Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Apr;18(4):974–983.
Journal cover image

Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

April 2020

Volume

18

Issue

4

Start / End Page

974 / 983

Location

United States

Related Subject Headings

  • Neoplasm Recurrence, Local
  • Liver Neoplasms
  • Humans
  • Hepatitis C, Chronic
  • Gastroenterology & Hepatology
  • Chemoembolization, Therapeutic
  • Carcinoma, Hepatocellular
  • Attitude
  • Antiviral Agents
  • 3202 Clinical sciences