Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States - PubMed (original) (raw)
Multicenter Study
Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States
Jessica A Davila et al. Ann Intern Med. 2011.
Abstract
Background: Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown.
Objective: To examine the prevalence and determinants of HCC surveillance among HCV-infected patients with cirrhosis in Veterans Affairs (VA) health care facilities in the United States.
Design: Retrospective cohort study of HCV-infected patients using data obtained from the national VA Hepatitis C Clinical Case Registry.
Setting: 128 VA medical centers.
Patients: HCV-infected patients with cirrhosis diagnosed between fiscal years 1998 and 2005.
Measurements: Abdominal ultrasonography and measurement of α-fetoprotein for HCC surveillance were identified from administrative data by using a previously validated algorithm. Patients were categorized as having routine (tests done during at least 2 consecutive years in the 4 years after cirrhosis diagnosis), inconsistent (at least 1 test, but not routine), or no surveillance in the 4 years after cirrhosis diagnosis. Predictors of surveillance were identified by using hierarchical random-effects regression.
Results: 126 670 patients with HCV were identified; 13 002 (10.1%) had cirrhosis. Approximately 42.0% of patients with cirrhosis received 1 or more HCC surveillance tests within the first year after the cirrhosis index date; however, a decline in receipt of surveillance was observed in the following 2 to 4 years. Among patients with cirrhosis and at least 2 years of follow-up, routine surveillance occurred in 12.0%, inconsistent surveillance in 58.5%, and no surveillance in 29.5%. Lower medical and psychological comorbid conditions, presence of varices, and the absence of decompensated liver disease were associated with a higher likelihood of receiving routine surveillance.
Limitations: Hepatocellular carcinoma surveillance tests were indirectly identified from registry data. Physician recommendations could not be captured.
Conclusion: Few HCV-infected veterans with cirrhosis received routine HCC surveillance. New strategies are needed to improve the implementation of HCC surveillance in clinical practice.
Primary funding source: Houston Veterans Affairs Health Services Research and Development Center of Excellence and the National Cancer Institute.
Comment in
- Summaries for patients: Screening for liver cancer in patients with hepatitis C virus infection and cirrhosis.
[No authors listed] [No authors listed] Ann Intern Med. 2011 Jan 18;154(2):I-36. doi: 10.7326/0003-4819-154-2-201101180-00002. Ann Intern Med. 2011. PMID: 21242351 No abstract available. - Surveillance for hepatocellular carcinoma.
Braillon A. Braillon A. Ann Intern Med. 2011 Aug 16;155(4):274-5; author reply 275. doi: 10.7326/0003-4819-155-4-201108160-00017. Ann Intern Med. 2011. PMID: 21844557 No abstract available. - Surveillance for hepatocellular carcinoma.
Kelley MJ. Kelley MJ. Ann Intern Med. 2011 Aug 16;155(4):274; author reply 275. doi: 10.7326/0003-4819-155-4-201108160-00016. Ann Intern Med. 2011. PMID: 21844558 No abstract available. - Surveillance for hepatocellular carcinoma.
Smoger SH. Smoger SH. Ann Intern Med. 2011 Aug 16;155(4):275; author reply 275. doi: 10.7326/0003-4819-155-4-201108160-00018. Ann Intern Med. 2011. PMID: 21844560 No abstract available.
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