Early detection – Clinical Value of Diagnostics https://clinicalvalue.com/en-au/ Fri, 28 Jun 2024 04:43:09 +0000 en-AU hourly 1 https://wordpress.org/?v=6.6.2 https://i0.wp.com/clinicalvalue.com/wp-content/uploads/2023/01/apple-touch-icon.png?fit=32%2C32&ssl=1 Early detection – Clinical Value of Diagnostics https://clinicalvalue.com/en-au/ 32 32 225041835 Challenges in early detection of HCC https://clinicalvalue.com/en-au/challenges-in-early-detection-of-hcc/ Fri, 28 Jun 2024 04:43:09 +0000 https://clinicalvalue.com/?p=8748 ...

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In a recent interview Associate Prof Simone Strasser provided valuable insights on the greatest challenges in early detection of Hepatocellular Carcinoma (HCC) surveillance in Australia.

Associate Prof Strasser commented “We are going to have emerging tools for HCC surveillance and that means we have to put a lot of effort to identify the people in the community who are at the greatest risk of developing liver cancer so that surveillance can be applied to them.”

What are the greatest challenges in early detection of HCC?

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Liver cancer surveillance: what’s stopping my patients getting tested? https://clinicalvalue.com/en-au/why-wont-my-patients-have-regular-testing-for-liver-cancer/ Sun, 26 May 2024 23:37:33 +0000 https://clinicalvalue.com/?p=8500 ...

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Liver cancer surveillance testing aims to detect hepatocellular cancer (HCC) early in our at risk patients, when curative treatment is still possible.1 In short, testing for liver cancer can help save and prolong the lives of those who are at risk. However, ongoing participation in surveillance programs is currently suboptimal. Read on to discover what could be stopping your patients from getting tested, and how you can help them stay on track with regular testing.

What are the current liver cancer surveillance recommendations?

Liver ultrasound is the current standard of care for HCC surveillance[4]. In general, testing with liver ultrasound should be done every 6 months in at-risk patients.1

Blood levels of alpha-fetoprotein (AFP), a tumour biomarker, may also be used in combination with ultrasound to improve HCC detection.1,2

HCC surveillance flow chart

Why don’t patients get tested?

Why might our patients miss out on HCC surveillance testing? Some of the reasons for missed tests and non-adherence with appointments are similar to any screening tests, such as other commitments (including family and work) and other health priorities. 4 Another patient factor at play is poor health literacy.4

But suboptimal surveillance uptake is not just down to our patients – it’s thought to be due to a combination of clinical and system-level barriers. 2

Clinician factors that can contribute to reduced patient participation in liver cancer surveillance programs include limited consultation time, competing clinical concerns and not being up-to-date with surveillance recommendations.2[5]

Other barriers[6] to liver cancer surveillance testing

The uptake of HCC surveillance testing may also be affected by some bigger-picture issues, such as misinformation and language barriers.1

People living in rural and remote areas of Australia may have limited access to quality ultrasound testing. This means they need to travel and pay for travel costs and accommodation, which can be a further barrier to testing.1

It’s also known that race and socio-economic status can further affect our patients’ participation in surveillance programs.2

People living in rural and remote areas of Australia may have limited access to quality ultrasound testing. This means they need to travel and pay for travel costs and accommodation, which can be a further barrier to testing.1

It’s also known that race and socio-economic status can further affect our patients’ participation in surveillance programs.2

Evidence review: Do at-risk patients take part in HCC surveillance programs?

A 2017 Australian retrospective study examined participation in, and adherence to, HCC surveillance. The study looked at patients with chronic hepatitis B who attended a community health centre that was supported by the Integrated Hepatitis B Service.4

The overall surveillance participation rate was 75%, and of the 67 patients who underwent HCC surveillance, adherence was considered:
● good in 18 patients (27%);
● suboptimal in 29 patients (43%); and
● poor in 20 patients (30%).

(Good adherence was defined as an average of ≥1 ultrasound every 7 months; suboptimal was an average of ≥1 but <2 scans every 14 months and poor was an average of <1 scan every 14 months.)

How can we improve liver cancer surveillance participation and adherence?

Factors associated with improved HCC surveillance include frequency of clinic visits and specialist service involvement, as well as higher socioeconomic status.4

A centralised HCC surveillance program, similar to that used in countries such as Japan and South Korea, may help deliver improved and more equitable care.2 The Japanese surveillance program includes free hepatitis testing and surveillance, dedicated educators and public awareness campaigns.

Other strategies that should be considered are clinician education, patient recall systems, nurse-led clinics and outreach invitations.2

Optimising primary care patient recall and abnormal results notification systems are priority actions identified by the 2023 Roadmap to Liver Cancer Control Australia[7].5[8]. This can be done by working with your medical practice software provider to set reminders.

What measures are needed to help at-risk Indigenous Australians?

The higher incidence of HCC and poor survival rates among Aboriginal and/or Torres Strait Islander people with HCC may stem from:2
● reduced access to testing;
● socio-environmental inequalities;
● cultural barriers; and
● distrust in the health care system.

While the use of mobile liver clinics in remote Indigenous communities has led to improved rates of HCC surveillance,6 further improving outcomes for Indigenous Australians with HCC poses an enormous challenge.6

The link between social determinants of health and the high rates of HCC and mortality suggests that to be successful, interventions will need to also involve public health measures that both reduce social disadvantage and improve access to care.6

Where can I find educational materials on liver disease?

The Liver Foundation[9] has information for both patients and health professionals[10], including:
● GP information[11];
● nurse information[12]; and
● patient information[13].

ThinkGP[AD14] also has information for GPs on liver disease[AD15], which qualifies as CPD hours for educational activities.

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Building modern hepatocellular carcinoma surveillance programmes: taking steps to address a leading cause of liver cancer death in Asia https://clinicalvalue.com/en-au/building-modern-hepatocellular-carcinoma-surveillance-programmes-taking-steps-to-address-a-leading-cause-of-liver-cancer-death-in-asia/ Wed, 23 Aug 2023 02:51:53 +0000 https://clinicalvalue.com/building-modern-hepatocellular-carcinoma-surveillance-programmes-taking-steps-to-address-a-leading-cause-of-liver-cancer-death-in-asia/ In this whitepaper, HCC surveillance programs in Asia were analysed. The learnings from well established HCC surveillance programs, as well as the challenges in areas that have not implemented such programs have highlighted 7 priorities for implementing an HCC surveillance program....

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Quick Summary

HCC is a leading cause of cancer mortality in Asia. Causes of HCC include viral hepatitis B and C infections, with recent increases in metabolic disorders, such as NAFLD, also playing a factor.

Early HCC interventions are highly effective and can lead to improved patient outcomes and survival. Therefore, HCC surveillance programs are pivotal in detecting HCC early and making the appropriate interventions.

In this whitepaper, HCC surveillance programs in Asia were analysed. The learnings from well established HCC surveillance programs in Asia, as well as the challenges in areas that have not implemented such programs have highlighted 7 priorities for implementing an HCC surveillance program:

  1. Include HCC surveillance in national program and strategic plans
    HCC surveillance programs should be fit into the national health strategy where appropriate, taking into account the local incidence and prevelance rates, and existing priorities and resources.
  2. Secure sustainable funding commitments
    Long-term resourcing and financing is key to making HCC survaillance programs successful. The current health financign system in the area, and ability to pay should be assessed, while exploring various funding methods such as centralised healthcare coverage or private insurance.
  3. Collect, analyse, and utilise data to inform program design
    The development of HCC surveillance program should be based on data, such as HCC epidemiology, patient outcomes, human and economic cost of HCC. These data should be collected and analysed.
  4. Adopt optimal technologies to advance HCC surveillance
    Technology can help to improve access to HCC surveillance programs, as well as improve patient outcomes by detecting HCC early. Some examples include: including additional biomarkers such as PIVKA-II, using biomarker based digital algorithms and diagnostic models, using more advanced imaging techniques, and adapting IT systems to support surveillance programs.
  5. Mobilise existing resources for HCC surveillance
    Tapping on exisiting resources to expand capacity for HCC care and surveillance., For example increasing the range of HCPs who can diagnose and manage HCC like primary and community HCPs, expanding private healthcare capacity in HCC care.
  6. Engage a broad spectrum of stakeholders to further surveillance goals
    Governmental decision-makers, physicians, patients and PAGs, payers and industry need to come together to drive implementation of a robust HCC surveillance programs that address needs of all stakeholders.
  7. Raise awareness and provide education on the need for HCC suveillance
    Raising the knowledge among the general population and HCPs on HCC and the importance of surveillance can improve uptake and compliance to surveillance programs.

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Liver Cancer in Japan: Dr Shun Kaneko on HCC Screening and Surveillance https://clinicalvalue.com/en-au/liver-cancer-in-japan-dr-shun-kaneko-on-hcc-screening-and-surveillance/ Fri, 09 Dec 2022 09:10:37 +0000 https://clinicalvalue.com/liver-cancer-in-japan-dr-shun-kaneko-on-hcc-screening-and-surveillance/ Japan is a global leader in hepatocellular carcinoma (HCC) surveillance, with an effective programme that enables early-stage carcinomas detection. Yet unmet needs continue to affect the management of HCC. Learn from Dr Shun Kaneko on Japan’s progress and challenges in HCC management. ...

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