Introduction Hepatocellular carcinoma (HCC) accounts for 90% of liver cancers and has a growing incidence of HCC worldwide. In 2013, liver cancer accounted for 2% of all cancers with an incidence of 5,413 new cases. 90–95% of cases of HCC arise in cirrhosis and non-cirrhotic chronic Hepatitis B.1 Outcomes are poor with a median survival of 11 months and a 3 year survival rate of 19%.2 Factors influencing outcome are multifactorial but evidence supports improved results through screening high risk groups.
The British Society of Gastroenterology (BSG) guidelines on the surveillance of HCC in high risk groups recommend 6 monthly liver ultrasound (USS) and serum alpha fetoprotein (AFP).
The ad hoc nature of our HCC surveillance contributed to the expansion of our liver service, including 2 liver specialist nurses and an electronic HCC surveillance database, all designed to provide a more robust system. The database includes appropriate patients and automatically flags up when surveillance is due. Has this service development had an impact of on patient care?
Methods A retrospective audit compares surveillance over 2 time periods: before and after the introduction of the database in January 2015. Data was obtained from the database and patient records. Deceased patients or those removed from the programme on clinical grounds were excluded from the cohorts. The following data was collected: gender, age, aetiology, CPS, date of diagnosis and the time interval between serum AFP measurements and liver imaging.
Results There is no significant difference in demographics between the 2 cohorts. The table below illustrates the percentages of patients undergoing surveillance within the guidelines. HCC was diagnosed in 5 patients (2 pre/3 post group) with a mean AFP of 13 mcg/l at diagnosis.
Conclusion Establishment of the database and the specialist nurse service has improved data collection reflected in the increased numbers undergoing surveillance. There is improved compliance, with detection & treatment of early HCC. Any delays were often due to patient cancellation, occasionally repeatedly, without a subsequent appointment being immediately arranged. So how could we improve further still? Recommendations may include; a cancellation failsafe mechanism, increased patient education with comprehensive information leaflet and more intelligent software that automatically sends an electronic reminder, as currently the database still relies on manual monitoring.
References 1 Forner A, et al. Hepatocellular carcinoma. Lancet 2012 March;379(9822):1245–55.
2 Greten TF, et al. Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Br J Cancer 2005 May;92(10):1862–1868.
Disclosure of Interest None Declared