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Ann Intern Med. 2011 Jan 18;154(2):85-93. doi: 10.7326/0003-4819-154-2-201101180-00006.

Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States.

Author information

  • 1The Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA. jdavila@bcm.tmc.edu

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.

PMID:
21242365
[PubMed - indexed for MEDLINE]
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