Inequalities in hepatocellular carcinoma (HCC) surveillance uptake in London: a UK multicentre cohort study

Abstract

Abstract Introduction Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related mortality worldwide. 6 monthly ultrasound surveillance for HCC is recommended by professional bodies, but fewer than 25% of patients receive surveillance at recommended intervals. The aim of this study was to describe surveillance uptake across a multicentre cohort, examining sociodemographic factors and predictors of surveillance attendance. Methods Electronic healthcare data from North West London primary care were used to identify numbers of patients with chronic liver disease between March 2021 and March 2023. A case review of patients eligible for HCC surveillance was then conducted using hospital care records. Data were collected including surveillance attendance and sociodemographic factors. Surveillance attendance was classified: regular (four surveillance episodes in 2 years), infrequent (less than four attendances) or non-attendance. Regression analysis was undertaken to examine factors associated with regular or reduced attendance. Results 2195 patients were identified as having cirrhosis from primary care; 869 patients were identified from hospital care records as being under the care of hepatology/gastroenterology clinics and eligible for surveillance. Of these, 17% patients received regular surveillance; 73% of patients were in receipt of infrequent surveillance and 10% received no surveillance over the study period. The strongest predictor of regular surveillance was care under a specialist hospital (OR 0.08, 95% CI 0.04 to 0.2, p<0.001). People who were not deprived were more likely to be regular attenders (OR 0.4, 95% CI 0.2 to 0.8, p=0.008). Conclusions Rates of regular HCC surveillance are low, with patients under the care of non-specialist centres most at risk of reduced attendance at surveillance. Our findings highlight the urgent need to address low surveillance uptake.