Clinical Presentation and Survival of Asian and Non-Asian Patients with HCV-Related Hepatocellular Carcinoma

Yip, Benjamin Hon Kei; Wantuck, James M.; Kim, Lily H.; Wong, Robert J.; Ahmed, Aijaz; García, Gabriel; Nguyen, Mindie H.

doi:10.1007/s10620-013-2948-7

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…As in other populations where carcinogenic viruses are endemic, PWID are infected at an early age and thus may develop HCC in mid- to late-adulthood, leading to losses of individuals in their most productive period of life (Yang & Roberts, 2010). The prognosis following diagnosis with HCC is extremely poor, and the median length of survival is 12–15 months (Yip, Wantuck, Kim, Wong, Ahmed, Garcia, & Nguyen, 2014). …”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis

Smith

Combellick

Jordan

et al. 2015

International Journal of Drug Policy

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Background Understanding HCV disease progression rates among people who inject drugs (PWID) is important to setting policy to expand access to detection, diagnosis and treatment, and in forecasting the burden of disease. In this paper we synthesize existing data on the natural history of HCV among PWID, including fibrosis progression rates (FPR) and the incidence of compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). Methods We conducted electronic and manual searches for published and unpublished literature. Reports were eligible if they (i) included participants who were chronically infected with HCV and reported current or previous injection drug use; (ii) presented original data on disease progression in a study sample comprised of at least 90% PWID; (iii) published between January 1, 1990, and December 31, 2013; and (iv) included data from upper-middle- or high-income countries. Quality ratings were assigned using an adaptation of the Quality In Prognosis Studies (QUIPS) tool. We estimated pooled FPRs using the stage-constant and stage-specific methods, and pooled incidence rates of CC, DC, and HCC. Results Twenty-one reports met the study inclusion criteria. Based on random-effect models, the pooled stage-constant FPR was 0.117 METAVIR units per year (95% CI, 0.099 −0.135), and the stage-specific FPRs were F0→F1, 0.128 (95% CI 0.080, 0.176); F1→F2, 0.059 (95% CI 0.035, 0.082); F2→F3, 0.078 (95% CI 0.056, 0.100); and F3→F4, 0.116 (95% CI 0.070, 0.161). The pooled incidence rates of CC, DC, and HCC were 6.6 (95% CI 4.8, 8.4), 1.8 (95% CI 0.3, 3.3), and 0.3 (95% CI −0.1, 0.6) events per 1,000 person-years, respectively. Following the stage-constant estimate, average time to cirrhosis is 34 years post-infection, and time to METAVIR stage F3 is 26 years; using the stage-specific estimates, time to cirrhosis is 46 years and time to F3 is 38 years. Conclusion Left untreated, PWID with chronic HCV infection will develop liver sequelae (including HCC) in mid- to late-adulthood. Delaying treatment with the new drug regimens until advanced fibrosis develops prolongs the period of infectiousness to perhaps thirty years. Scaling up of effective HCV prevention and early engagement in care and treatment will facilitate the elimination HCV as a source of serious disease in PWID.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis

Smith

Combellick

Jordan

et al. 2015

International Journal of Drug Policy

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“…Our mean (median) of 4.8 (4.2) years from HCV diagnosis to death among all those who died is consistent with a report from the Massachusetts Department of Health showing that 8,373 (11%) of 76,122 HCV cases reported between 1992‐2009 died during this period, with a median of 3 years from first report (not including any time from diagnosis to report) to death . It is striking that a quarter of African‐Americans as well as those on Medicare were diagnosed late; differential delay in HCV diagnosis by race has been found in other populations as well …”

Section: Discussionmentioning

confidence: 99%

Late diagnosis of hepatitis C virus infection in the Chronic Hepatitis Cohort Study (CHeCS): Missed opportunities for intervention

Moorman

Xing

et al. 2015

Hepatology

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To determine stage of liver disease at initial diagnosis of hepatitis C virus (HCV) infection, we analyzed data from the Chronic Hepatitis Cohort Study (CHeCS), a large US observational study. We examined the temporal relationships of initial HCV infection diagnosis with cirrhosis--defined by liver biopsy or mean FIB-4 score >5.88--and time to onset of cirrhotic decompensation in electronic medical records. We determined time in health system prior to HCV diagnosis and rates of hospitalization and death following HCV diagnosis. Of 14,717 patients with chronic HCV seen during 2006–2011, 6,166 (42%) had a definable time of initial HCV diagnosis. Of these, 1,056 (17%) patients met our definition for “late diagnosis” with either cirrhosis concurrent with initial HCV diagnosis (n=550), a first diagnosis of hepatic decompensation before or within 12 months after initial HCV diagnosis (n=506), or both (n=314). Patients with late diagnosis had an average of 6 years in the health system before their HCV diagnosis. In a comparison with patients without late diagnosis, hospitalization (59% vs 35%) and death (33% vs 9%) were more frequent among patients with late diagnosis. Among all who died, mean (median) time from initial HCV diagnosis to death was 4.8 (4.2) years. Conclusion Many CHeCS patients had advanced liver disease concurrent with their initial HCV diagnosis despite many years of engagement with the health care system, and these patients had high rates of hospitalization and mortality.

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“…Hepatitis C and alcoholic fatty liver disease significantly increase the risk of developing serious liver diseases, such as cancer and cirrhosis, but are primarily acquired through intravenous drug use and chronic alcohol abuse [35, 36]. The cessation of substance abuse is a complex process involving addiction and withdrawal management [37].…”

Section: Results: Demonstration Of the Methodology Used To Develop Nementioning

confidence: 99%

The Asian Grocery Store-Based Cancer Education Program: Creating New Education Modules

et al. 2015

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Purpose Operating since 1994, the UCSD Moores Cancer Center’s Asian Grocery Store-Based Cancer Education Program (the Program) is a proven and sustainable strategy for disseminating cancer and poison control information to Asian and Pacific Islander (API) communities. This paper describes the process taken to identify health topics that can be readily addressed within the Program’s infrastructure, and reports results of the pilot testing of the educational module that was developed by following that process. Methods The development of each new module is guided by the Health Belief Model and the Tipping Point Model. The process starts with the selection of a health topic demonstrating pressing need and treatment options in the API community. Then, using the Pareto Principle, reasonably modifiable risk factors are chosen to be addressed in the module. “Sticky messaging” for the modifiable risk factors is developed to package the health information as memorable and transmissible calls-to-action. Finally, grocery store outreaches were used to pilot test the new module to assess its effectiveness at facilitating health care information to API community members. Results By adhering to the steps described in this paper, the authors were able to: (1) select liver cancer as a pressing API health issue that could be positively impacted by the Program; (2) identify reasonably modifiable risk factors for the chosen health issue; (3) generate compelling call-to-action messages to decrease risk of exposure; and (4) demonstrate the cultural and linguistic alignment of the liver cancer control module. Conclusion The development and testing of new health education modules follow a methodical process guided by scientific principles. Understanding and employing the elements of an existing evidence-based and sustainable health education program can increase the likelihood of success in addressing the health needs of the API community.

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Clinical Presentation and Survival of Asian and Non-Asian Patients with HCV-Related Hepatocellular Carcinoma

Cited by 25 publications

References 30 publications

Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis

Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis

Late diagnosis of hepatitis C virus infection in the Chronic Hepatitis Cohort Study (CHeCS): Missed opportunities for intervention

The Asian Grocery Store-Based Cancer Education Program: Creating New Education Modules

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