The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
The Center for the Advancement of Team Science, Systems Thinking in Health Services and Implementation Science Research (CATALYST, The Ohio State University College of Medicine, AnalyticsColumbus, OH, 43210, USA.
J Gastrointest Cancer. 2023 Jun;54(2):332-356. doi: 10.1007/s12029-022-00851-x. Epub 2022 Jul 26.
Hepatocellular carcinoma has a dismal prognosis, except in patients diagnosed early who are candidates for potentially curative therapies. Most HCC cases develop in patients with chronic liver disease. Therefore, expert society guidelines recommend surveillance every 6 months with ultrasound with or without serum alpha-fetoprotein for high-risk patients. However, fewer than 20% of patients in the USA undergo appropriate surveillance.
A systematic scoping review was performed with the objective of identifying barriers to screening among high-risk patients in the USA including mapping key concepts in the relevant literature, identifying the main sources and types of evidence available, and identifying gaps in the literature. A total of 43 studies published from 2007 to 2021 were included. Data were extracted and a conceptual framework was created.
Assessment of quantitative studies revealed poor surveillance rates, often below 50%. Three categories of barriers to surveillance were identified: patient-level, provider-level, and system-level barriers. Prevalent patient-level barriers included financial constraints, lack of awareness of surveillance recommendations, and scheduling difficulties. Common provider-level barriers were lack of provider awareness of guidelines for surveillance, difficulty accessing specialty resources, and time constraints in the clinic. System-level barriers included fewer clinic visits and rural/safety-net settings. Proposed interventions include improved patient/provider education, patient navigators, increased community/academic collaboration, and EMR-based reminders.
Based on these findings, there is a crucial need to implement and evaluate proposed interventions to improve HCC surveillance.
肝细胞癌的预后较差，除了那些有机会接受潜在治愈性治疗的早期诊断患者。大多数 HCC 病例发生在患有慢性肝病的患者中。因此，专家协会指南建议高危患者每 6 个月进行一次超声检查，无论是否有血清甲胎蛋白，并建议高危患者每 6 个月进行一次超声检查，无论是否有血清甲胎蛋白。然而，在美国，只有不到 20%的患者接受了适当的监测。
进行了系统的范围界定审查，目的是确定美国高危患者筛查的障碍，包括在相关文献中映射关键概念，确定现有主要来源和类型的证据，以及确定文献中的差距。共纳入了 2007 年至 2021 年期间发表的 43 项研究。提取数据并创建了一个概念框架。
对定量研究的评估显示，监测率很差，通常低于 50%。确定了三类监测障碍：患者层面、提供者层面和系统层面的障碍。常见的患者层面障碍包括经济限制、缺乏对监测建议的认识以及预约困难。常见的提供者层面障碍包括提供者对监测指南的认识不足、难以获得专科资源以及诊所时间限制。系统层面的障碍包括就诊次数减少和农村/安全网环境。拟议的干预措施包括改善患者/提供者教育、患者导航员、增加社区/学术合作以及基于 EMR 的提醒。
基于这些发现，迫切需要实施和评估拟议的干预措施，以改善 HCC 监测。
