Catching Them Early: Outreach Program Could Avert HCC in Cirrhosis Patients

Surabhi Dangi-Garimella, PhD

A prospective trial that reached out to patients with cirrhosis to undergo an ultrasound screen, with or without the assistance of a patient navigator, found that the outreach effort doubled the percentage of patients who were screened for hepatocellular carcinoma (HCC).
Patients with liver cirrhosis are highly susceptible to developing HCC, a disease that has a dismal 5-year survival rate of 17.5%. Despite recommendations from national guidelines, only 25% of patients with liver cirrhosis get an ultrasound screening every 6 months. For their study, the authors randomly assigned patients diagnosed with liver cirrhosis between December 2014 and March 2016 to groups that received a mailed invitation for an ultrasound screen (N = 600), mailed invitation for an ultrasound screen and patient navigation (N = 600), or usual care (N = 600). The mailing was followed up with up to 3 phone calls if patients did not respond. The trial endpoint was abdominal imaging within 6 months of being randomized.
Based on medical claims data, 79.6% of patients were documented to have cirrhosis, while 20.4% were suspected to have cirrhosis based on non-invasive markers of fibrosis. The study found that nearly double the number of patients in the mailed invitation plus navigator (47.2%) and mailed invitation alone (44.5%) groups underwent screening, compared with those who received usual care (24.3%, P <.001, for both comparisons). However, presence of the navigator did not seem to influence patient decisions to get screened beyond the impact of the mailer and follow-up calls. The authors did not observe differences in screening rates based on race, documented versus suspected cirrhosis, or receipt of gastroenterology care.
The authors concluded that their study points to the underuse of HCC screening in clinical practice. They recommended a more aggressive population health outreach to improve screening for early detection of HCC particularly in the higher risk cirrhosis patients.
Singal AG, Tiro JA, Marrero JA, et al. Mailed outreach program increases ultrasound screening of patients with cirrhosis for hepatocellular carcinoma [published online November 5, 2016]. Gastroenterology. pii: S0016-5085(16)35321-5 doi:
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