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Clin Gastroenterol Hepatol. 2019 Jul 26. pii: S1542-3565(19)30786-4. doi: 10.1016/j.cgh.2019.07.042. [Epub ahead of print]

Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients with Hepatocellular Carcinoma.

Author information

1
Division of Digestive and Liver Disease, UT Southwestern Medical Center.
2
Division of Digestive and Liver Diseases, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center.
3
Division of Liver Diseases, Icahn School of Medicine at Mount Sinai.
4
Texas Liver Institute, University of Texas Health San Antonio.
5
Division of Gastroenterology and Hepatology, University of Colorado Denver School of Medicine.
6
Division of Gastroenterology and Hepatology, University of Michigan.
7
Division of Gastroenterology, University of California San Francisco.
8
Division of Gastroenterology and Hepatology, Henry Ford Hospital.
9
T.E. Starzl Transplantation Institute and Center for Liver Disease, University of Pittsburgh Medical Center.
10
Division of Hepatology, Northwestern University.
11
Transplantation Institute and Division of Gastroenterology, Loma Linda University Health.
12
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine.
13
Division of Gastroenterology and Hepatology, Duke University Health Center.
14
Division of Gastroenterology and Research and Development, Veterans Affairs Puget Sound Healthcare System and University of Washington.
15
Division of Gastroenterology and Hepatology, University of Pennsylvania.
16
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine.
17
Division of Gastroenterology, Georgetown University Hospital.
18
Division of Gastroenterology, Rush Medical College.
19
Division of Digestive and Liver Diseases, Columbia University.
20
Division of Gastroenterology and Hepatology, Oregon Health and Science University.
21
Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center.
22
Division of Gastroenterology, Hepatology and Nutrition, University of Chicago.
23
Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. Debakey VA Medical Center.
24
Division of Gastroenterology and Hepatology, Alameda Health System.
25
Division of Hepatology, Loyola University Medical Center and Edward Hines Veterans Affairs.
26
Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center.
27
Division of Gastroenterology and Hepatology, University of New Mexico.
28
Division of Gastroenterology, Hepatology and Nutrition, University of Utah.
29
Division of Gastroenterology and Hepatology, Weill Cornell Medicine - New York-Presbyterian Hospital.
30
Division of Gastroenterology and Hepatology, University of California San Diego.
31
Division of Organ Transplantation, Scripps Green Hospital.
32
Division of Transplant Surgery, University of Tennessee Health Science Center.
33
Liver Institute at Methodist Dallas.
34
Division of Abdominal Transplantation, Baylor College of Medicine.
35
Division of Gastroenterology and Hepatology, McGuire VA Medical Center.
36
Organ Transplant Department, Swedish Medical Center.
37
Division of Gastroenterology and Hepatology, Mayo Clinic.
38
Digestive Disease & Surgery Institute, Cleveland Clinic.
39
Division of Gastroenterology, Washington University School of Medicine.
40
Banner Transplant Institute, Banner - University Medical Center Phoenix.
41
Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center.
42
Oschner Multi-Organ Transplant Institute, Oschner Health System.
43
Division of Gastroenterology and Hepatology, Stanford University.

Abstract

BACKGROUND & AIMS:

Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC.

METHODS:

We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%).

RESULTS:

Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete responses to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3-12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3-12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE.

CONCLUSION:

Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.

KEYWORDS:

HCV; Liver cancer; TACE; drug

PMID:
31357028
DOI:
10.1016/j.cgh.2019.07.042

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