A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma

Abstract

Objective Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings. Design UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals. Results Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%). Conclusions In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.

Patient understanding of liver cirrhosis and improvement using multimedia education

“…Further efforts to educate patients as to the purpose and value of HCC surveillance may help to enhance this service, which has recently been evaluated as requiring substantial development in order to improve outcomes for patients with HCC. 12 In light of the rising prevalence of chronic liver disease, the work presented here will be extended to generate empirical evidence as to whether multimedia education improves factors such as HCC screening attendance, medication adherence and their associated health outcomes. This work will involve a larger patient cohort and evaluate the persistence of improved patient knowledge over a longer time period.…”

Implementation of the Lancet Standing Commission on Liver Disease in the UK

“…Serious defi ciencies in the provision of interventional radiology in England were identifi ed as a bottleneck in attempting to improve clinical outcomes in other areas of medicine 17 as well as in the national survey of HCC surveillance. 18,19 The association between the route a patient with primary HCC takes to diagnosis and relative survival estimates 20,21 has been examined by PHE in updated data. Only 8% of HCCs diagnosed between 2006 and 2008 were referred through the 2 week wait route and 18% by non-2-week wait GP referral.…”

Surveillance for hepatocellular cancer

“…15,17 Critically, in the UK 30% of patients did not receive written or verbal information regarding surveillance. 16 Consequently, patients are often not giving informed consent to participation and are not aware of its limitations or the frequent need for further investigations after an initial abnormal ultrasound scan. This too may have an impact on patient compliance with screening ultrasonography.…”