Davila PhD, Jennifer R. Kramer PhD, MPH, Zhigang Duan MD, MS,
Richardson PhD, Gia L. Tyson MD, Yvonne H. Sada MD, Fasiha Kanwal MD, MPH, Hashem
B. El-Serag MD, MPH
treatment for hepatocellular carcinoma (HCC)—liver cancer—could be influenced
by place of HCC diagnosis (hospitalization vs. outpatient), subspecialty
referral following diagnosis, as well as physician and facility factors. We
conducted a study to examine the effect of patient and non-patient factors on
the place of HCC diagnosis, referral, and treatment in Veterans Administration
(VA) hospitals in the United States.
Hepatitis C Clinical Case Registry, we identified HCV-infected patients who
developed HCC during 1998-2006. All cases were verified and staged according to
Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of
HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We
examined factors related to these outcomes using hierarchical logistic
regression. These factors included HCC stage, HCC surveillance, physician
specialty, and facility factors, in addition to risk factors, co-morbidity, and
liver disease indicators.
37.2% of the 1,296 patients with HCC were diagnosed during hospitalization,
31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being
seen by a surgeon or oncologist was associated with surveillance (adjusted odds
ratio (aOR) =1.47;95%CI:1.20-1.80) and varied by geography (1.74;1.09-2.77).
Seeing a surgeon or oncologist was predictive of treatment (aOR=1.43;95%CI:1.24-1.66).
There was a significant increase in treatment among patients who received
surveillance (aOR=1.37; 95%CI:1.02-1.71), were seen by gastroenterology
(1.65;1.21-2.24) or were diagnosed at a transplant facility (1.48;1.15-1.90).
40% of patients were diagnosed during hospitalization. Most patients were not
seen by a surgeon or oncologist for treatment evaluation and only 34% received
treatment. Only receipt of HCC surveillance was associated with increased
likelihood of outpatient diagnosis, being seen by a surgeon or oncologist, and
treatment. (HEPATOLOGY 2013.) (HEPATOLOGY 2013.)
31% of all HCC patients were seen by a surgeon or oncologist for treatment
evaluation.” The authors partially
attributed this low number to the lack of knowledge among medical providers
that there are effective treatments to treat HCC and they recommended that
regardless of HCC stage that all patients with HCC should be evaluated for
treatment by a specialist.
early detection results in better outcomes.
So the take home message is that if you have chronic hepatitis B you
should be monitored for liver cancer on a regular basis with an ultrasound test
and an alpha fetoprotein(AFP) test—a marker for liver cancer. Typically, a medical provider will monitor
someone with hepatitis C once they develop stage 3 fibrosis with AFP and
ultrasound. The best advice is to talk
with your medical provider about when you should be monitored and take care of your
liver by avoiding alcohol, eating a healthy diet, stress reduction and HCV
antiviral treatment as needed.