title: Current practices in management of hepatocellular carcinoma in India: results of an online survey.
abstract: BACKGROUND
  Prior to INASL guidelines, there were no Indian guidelines for management of hepatocellular carcinoma (HCC) in India. The guidelines given by other societies like AASLD, EASL etc are not uniform and not tailored for Indian patients. Hence management practices for HCC in India largely depended on physicians' individual preferences. This survey aimed to study current practices in management of HCC in India.
  
  
  METHODS
  An online survey was conducted from the platform of a survey portal (www.surveymonkey.com), from December 2012 to April 2013. Invitation to participate in the survey was sent to 1383 doctors of India who were expected to be involved in management of patients of HCC. The survey was of 10 min duration and consisted of questions on how the respondents diagnosed and managed patients of HCC.
  
  
  RESULTS
  Three hundred and seventy-seven doctors answered the survey questions (72% gastroenterologists, 95% working in India). The important points which emerged from the survey are following: (i) The incidence of HCC is increasing in India; (ii) The most common etiologic agent is Hepatitis B responsible for 43% cases; (iii) Only 14% patients present in early stage when curative treatment is possible (BCLC-A); (iv) 90% of these respondents screen for HCC when they first evaluate a cirrhotic patient; (v) While following a patient of cirrhosis most respondents screen for HCC by ultrasound and AFP at every 6 months to 1 year; and (vi) Most (82%) respondents follow some international guideline for staging and treatment of HCC. The respondents also suggested that there is a need for spreading awareness about HCC in public as well as in medical fraternity, and there is a need for a national registry of HCC.
  
  
  CONCLUSIONS
  This is the first survey on management practices on HCC. With the publication of the INASL guidelines on HCC, the diagnosis and treatment of HCC will be more uniform and protocol based. Further such surveys should be carried out at periodic interval to track increasing awareness and better management practices for HCC in India.
authors.affiliation: Department of Gastroenterology & Hepatology, Ganga Ram Institute for Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
keywords: AASLD, American Association for the Study of Liver Diseases; AFP, alpha–fetoprotein; BCLC, Barcelona clinic liver cancer; CECT, contrast enhanced computerized tomography; CTP, Child Turcotte Pugh; EASL, European Association for the Study of the Liver; ESDO, European Society of Digestive Oncology; FNAC, fine needle aspiration cytology; GI, gastro-intestinal; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; INASL, Indian National Association for the Study of Liver; MBBS, Bachelor of Medicine, Bachelor of Surgery; SOL, space occupying lesion; TACE, transcatheter arterial chemoembolization; guidelines; hepatocellular carcinoma; liver cancer; management practices; survey