Needs for hepatocellular carcinoma control policy in the Asia-Pacific region.
BACKGROUND
Hepatocellular carcinoma (HCC) is particularly burdensome in the Asia-Pacific region, however, cross-country comparisons have been limited to somewhat unreliable epidemiological measures. We conducted a comparative needs assessment for HCC control policy to inform HCC control efforts in the Asia-Pacific region. The aims were to identify regional needs, to compare overall competence across the region, and to identify which needs were concordant across the region.


METHODS
Using the self-explicated method, a stated-preference approach, clinical experts from Australia, China, Japan, Korea, Taiwan, and the United States valued ten previously identified dimensions of HCC control: clinical education; risk assessment; HBV strategy; HCV strategy; life-style risk factors; national statistics; funding for screening; funding for treatment; political awareness; and public awareness. Results were normalized and analyzed using Z-scores and ANOVA, with concordance of need across the region tested via the F-test.


RESULTS
Seventy-two respondents, equally drawn from the study sites, completed the survey (response rate: 36%). Respondents were hepatologists (39%), oncologists (21%), radiologists (17%), surgeons (17%), and other specialists (7%) who were involved in liver cancer control at local/regional (35%) national (44%) or international (21%) levels. In aggregate, the most significant needs were political awareness, public awareness, and life-style risk factors (all p<0.001). Significant differences in aggregate competence were observed across the region (p<0.001), with better than expected competence reported by respondents from Taiwan (p<0.001), Japan (p=0.006), and Korea (0.041), and close to expected competence reported by respondents from Australia, China, and USA (all p>0.05). There were differences in the extent of needs across the region (p<0.05) on all dimensions except funding for screening, clinical education and life style risk factors.


CONCLUSIONS
As the first comparative needs assessment for HCC for the Asia-Pacific region, our results can inform national and cross-national priorities for intervention and facilitate the identification of best practices. Regional efforts to control HCC should adopt as objectives the needs for greater political and public awareness and improved management of lifestyle risk factors because these are the most significant needs, and are shared concerns across the region.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. jbridges@jhsph.edu
John F P
JF
Bridges
Susan M
SM
Joy
Gisselle
G
Gallego
Masatoshi
M
Kudo
Sheng-Long
SL
Ye
Kwang-Hyub
KH
Han
Ann-Lii
AL
Cheng
Barri M
BM
Blauvelt
D001208:Asia / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control*; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D008403:Mass Screening; D020380:Needs Assessment; D010140:Pacific Ocean / Q000453:epidemiology; D011640:Public Policy; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires