Improving hepatocellular carcinoma screening among cirrhosis patients

Background

The incidence and mortality rates from hepatocellular carcinoma (HCC) are increasing in the United States and North Carolina. HCC prognosis has remained persistently poor in part due to underutilization of HCC surveillance. Despite evidence that regular HCC surveillance in patients with cirrhosis, or late stage scarring of the liver, has been associated with earlier detection and improved survival, a minority of individuals with cirrhosis receive screening.  

In conjunction, Hepatitis C virus (HCV) remains a leading cause of cirrhosis and HCC, and HCV affects many patients in NC. In recent years, the introduction of direct acting antivirals (DAAs) has led to a dramatic increase in the number of patients with HCV and cirrhosis achieving HCV cure. Given the simplicity of these regimens, DAAs are increasingly being prescribed by community providers. This has led to increased access to HCV treatment and cure but could lead to missed HCC screening opportunities. Providers might not evaluate HCV-cured patients for cirrhosis and may not adequately assess HCC risk.  

HCC risk stratification models that utilize standard of care HCV lab results may improve the identification of HCV patients at risk of HCC and increase HCC surveillance rates. The benefits of these risk-stratification tools are likely to be greatest in the community setting, leading to decreased disparities in HCC care. 

Our Strategy

Improving hepatocellular carcinoma screening among cirrhosis patients from North Carolina using lab-based risk stratification tools aims to improve HCC screening and improve HCC outcomes in NC, particularly among patients in resource-limited settings.  

The objectives of this application are to improve understanding of current HCC surveillance patterns in NC and understand the feasibility of incorporating risk stratification tools to help community primary care providers and gastroenterologists identify high-risk patients for referral to active screening programs. 

The project will accomplish these goals by assessing current HCC surveillance practices in North Carolina, validating existing lab-based HCC risk stratification tools among North Carolina patients with treated HCV and surveying community providers to assess attitudes and behaviors and identify interested providers for a subsequent pilot to test the use of point-of-care HCC risk stratification tools.  

This study is funded by the UNC Lineberger Comprehensive Cancer Center. The Principal Investigators are Drs Louise Henderson and Andrew Moon.