Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Hepatology. 2017 Mar;65(3):875-884. doi: 10.1002/hep.28770. Epub 2016 Oct 1.


Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.25-7.62) and significantly lower in those reporting barriers to surveillance (OR, 0.42; 95% CI, 0.25-0.70).

Conclusion: Patients with cirrhosis are knowledgeable and interested in HCC surveillance; however, patient-reported barriers are associated with lower surveillance rates in clinical practice and represent potential intervention targets to improve HCC surveillance effectiveness. (Hepatology 2017;65:875-884).

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Attitude to Health
  • Carcinoma, Hepatocellular / diagnosis*
  • Carcinoma, Hepatocellular / epidemiology
  • Early Detection of Cancer / standards*
  • Early Detection of Cancer / trends
  • Educational Status
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / epidemiology
  • Liver Neoplasms / diagnosis*
  • Liver Neoplasms / epidemiology
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Population Surveillance
  • Racial Groups
  • Risk Assessment
  • Self Report
  • Socioeconomic Factors
  • United States