scholarly journals The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2251
Author(s):  
Shari S. Rogal ◽  
Vera Yakovchenko ◽  
Rachel Gonzalez ◽  
Angela Park ◽  
Lauren A. Beste ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Population Based ◽  
Veterans Health ◽  
Multivariate Models ◽  
Advanced Liver Disease ◽  
National Healthcare ◽  
Clinical Reminder ◽  
Quasi Experimental ◽  
Hepatocellular Carcinoma Surveillance ◽  
Innovation Team

After implementing a successful hepatitis C elimination program, the Veterans Health Administration’s (VHA) Hepatic Innovation Team (HIT) Collaborative pivoted to focus on improving cirrhosis care. This national program developed teams of providers across the country and engaged them in using systems redesign methods and population health approaches to improve care. The HIT Collaborative developed an Advanced Liver Disease (ALD) Dashboard to identify Veterans with cirrhosis who were due for surveillance for hepatocellular carcinoma (HCC) and other liver care, promoted the use of an HCC Clinical Reminder in the electronic health record, and provided training and networking opportunities. This evaluation aimed to describe the VHA’s approach to improving cirrhosis care and identify the facility factors and HIT activities associated with HCC surveillance rates, using a quasi-experimental design. Across all VHA facilities, as the HIT focused on cirrhosis between 2018–2019, HCC surveillance rates increased from 46% (IQR 37–53%) to 51% (IQR 42–60%, p < 0.001). The median HCC surveillance rate was 57% in facilities with high ALD Dashboard utilization compared with 45% in facilities with lower utilization (p < 0.001) and 58% in facilities using the HCC Clinical Reminder compared with 47% in facilities not using this tool (p < 0.001) in FY19. Increased use of the ALD Dashboard and adoption of the HCC Clinical Reminder were independently, significantly associated with HCC surveillance rates in multivariate models, controlling for other facility characteristics. In conclusion, the VHA’s HIT Collaborative is a national healthcare initiative associated with significant improvement in HCC surveillance rates.

scholarly journals Overdiagnosis: An Understudied Issue in Hepatocellular Carcinoma Surveillance

2017 ◽  
Vol 37 (04) ◽  
pp. 296-304 ◽  
Author(s):  
Nicole Rich ◽  
Neehar Parikh ◽  
Amit Singal
Keyword(s):  
Quality Of Life ◽  
Hepatocellular Carcinoma ◽  
Side Effects ◽  
Early Detection ◽  
Solid Tumors ◽  
Population Based ◽  
Lung Cancers ◽  
Hepatocellular Carcinoma Surveillance

AbstractOverdiagnosis, the detection of clinically insignificant disease that would not otherwise impact the patient's lifespan, is a phenomenon that has been described in several solid tumors, such as prostate, breast, thyroid, and lung cancers. Population-based efforts to reduce hepatocellular carcinoma (HCC) mortality in cirrhosis patients by screening and early detection may result in the overdiagnosis of HCC. One of the harms of overdiagnosis is subsequent overtreatment, which can result in increased costs, as well as physical side effects, psychological harms, and poorer quality of life. In this review, the authors explore the potential for overdiagnosis in HCC.

scholarly journals Tu1447 - Adherence to Hepatocellular Carcinoma Surveillance Guidelines in Patients with Liver Cirrhosis: A Population-Based Real-World Study

2018 ◽  
Vol 154 (6) ◽  
pp. S-1218-S-1219
Author(s):  
Yee Hui Yeo ◽  
Donghak Jeong ◽  
Biyao Zou ◽  
Eiichi Ogawa ◽  
Dong Hyun Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Real World ◽  
Population Based ◽  
Hepatocellular Carcinoma Surveillance

823 HEPATOCELLULAR CARCINOMA SURVEILLANCE PROCESS FAILURES IN PATIENTS WITH CIRRHOSIS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1295
Author(s):  
Patrick C. Marquardt ◽  
Po-Hong Liu ◽  
Joshua Immergluck ◽  
Nicole E. Rich ◽  
Adam Yopp ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatocellular Carcinoma Surveillance ◽  
Process Failures

scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p &lt; .001) and 1.08-fold (95% CI = 1.05–1.10, p &lt; .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p &lt; .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p &lt; .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p &lt; .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

scholarly journals Does access to care play a role in liver cancer survival? The ten-year (2006–2015) experience from a population-based cancer registry in Southern Italy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Walter Mazzucco ◽  
Francesco Vitale ◽  
Sergio Mazzola ◽  
Rosalba Amodio ◽  
Maurizio Zarcone ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Access To Care ◽  
Cancer Registry ◽  
Health Care Services ◽  
Cancer Survival ◽  
Developed Countries ◽  
Population Based ◽  
Easy Access ◽  
Net Survival ◽  
Poor Access

Abstract Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.

scholarly journals The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study

2021 ◽  
Vol 28 (1) ◽  
pp. 396-404
Author(s):  
Irene S. Yu ◽  
Shiru L. Liu ◽  
Valeriya Zaborska ◽  
Tyler Raycraft ◽  
Sharlene Gill ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Tumor Board ◽  
Treatment Center ◽  
Population Based Study ◽  
Therapeutic Modalities ◽  
Quaternary Center ◽  
Statistics Canada ◽  
The Impact

Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; p < 0.001), Child–Pugh A (94% vs. 83% vs. 80%; p = 0.022), and hepatitis B (37% vs. 15% vs. 4%; p < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; p = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; p = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; p < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; p = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.

Effect of Pokémon GO on incidence of fatal traffic injuries: a population-based quasi-experimental study using the national traffic collisions database in Japan

2017 ◽  
Vol 24 (6) ◽  
pp. 448-450 ◽  
Author(s):  
Sachiko Ono ◽  
Yosuke Ono ◽  
Nobuaki Michihata ◽  
Yusuke Sasabuchi ◽  
Hideo Yasunaga
Keyword(s):  
Experimental Study ◽  
Traffic Accident ◽  
Regression Discontinuity ◽  
Population Based ◽  
National Data ◽  
Difference In Differences ◽  
Quasi Experimental ◽  
Accident Research ◽  
Pokémon Go ◽  
Augmented Reality Game

Pokémon GO (Niantic Labs, released on 22 July 2016 in Japan) is an augmented reality game that gained huge popularity worldwide. Despite concern about Pokémon GO–related traffic collisions, the effect of playing Pokémon GO on the incidence of traffic injuries remains unknown. We performed a population-based quasi-experimental study using national data from the Institute for Traffic Accident Research and Data Analysis, Japan. The outcome was incidence of traffic injuries. Of 127 082 000 people in Japan, 886 fatal traffic injuries were observed between 1 June and 31 August in 2016. Regression discontinuity analysis showed a non-significant change in incidence of fatal traffic injuries after the Pokémon GO release (0.017 deaths per million, 95%CI −0.036 to 0.071). This finding was similar to that obtained from a difference-in-differences analysis. Effect of Pokémon GO on fatal traffic injuries may be negligible.

635 Primary Care Provider Knowledge Regarding Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis

2014 ◽  
Vol 146 (5) ◽  
pp. S-916-S-917
Author(s):  
Eimile Dalton-Fitzgerald ◽  
Jasmin A. Tiro ◽  
Pragathi Kandunoori ◽  
Adam Yopp ◽  
Amit G. Singal
Keyword(s):  
Hepatocellular Carcinoma ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Provider Knowledge ◽  
Hepatocellular Carcinoma Surveillance
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