Author information
1Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX; Department of Clinical Sciences, University of Texas Southwestern, Dallas, TX; Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX.
2Department of Clinical Sciences, University of Texas Southwestern, Dallas, TX.
3Department of Clinical Sciences, University of Texas Southwestern, Dallas, TX; Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX.
4Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX.
5Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX; Department of Surgery, University of Texas Southwestern, Dallas, TX.
Abstract
BACKGROUND:
Fewer than 1 in 5 patients receive hepatocellular carcinoma surveillance; however, most studies were performed in racially and socioeconomically homogenous populations and few used guideline-based definitions for surveillance.
AIMS:
To characterize guideline-consistent hepatocellular carcinoma surveillance rates and identify determinants of hepatocellular carcinoma surveillance among a racially and socioeconomically diverse cohort of cirrhotic patients.
METHODS:
We retrospectively characterized hepatocellular carcinoma surveillance among cirrhotic patients followed between July 2008 and July 2011 at an urban safety-net hospital. Inconsistent surveillance was defined as at least one screening ultrasound during the 3-year period, annual surveillance as screening ultrasounds every 12 months, and biannual surveillance as screening ultrasounds every 6 months. Univariate and multivariate analyses were conducted to identify predictors of surveillance.
RESULTS:
Of 904 cirrhotic patients, 603 (67%) underwent inconsistent surveillance. Failure to recognize cirrhosis was a significant barrier to surveillance utilization (p<0.001). Inconsistent surveillance was associated with insurance status (OR 1.43, 95%CI 1.03-1.98), multiple primary care visits per year (OR 2.63, 95%CI 1.86-3.71), multiple hepatology visits per year (OR 3.75, 95%CI 2.64-5.33), African American race (OR 0.61, 95%CI 0.42-0.99), nonalcoholic steatohepatitis etiology (OR 0.60, 95%CI 0.37-0.98), and extrahepatic cancer (OR 0.43, 95%CI 0.24-0.77). Only 98 (13.4%) of 730 patients underwent annual surveillance, and only 13 (1.7%) of 786 had biannual surveillance.
CONCLUSIONS:
Only 13% of patients with cirrhosis receive annual surveillance and less than 2% receive biannual surveillance. There are racial and socioeconomic disparities, with lower rates of hepatocellular carcinoma surveillance among African Americans and underinsured patients.