title: Nurse-led hepatocellular carcinoma surveillance clinic provides an effective method of monitoring patients with cirrhosis.
abstract: The aim of this study is to examine the acceptability and effectiveness of a nurse-led hepatocellular carcinoma (HCC) surveillance clinic in high-risk patients with cirrhosis/advanced fibrosis. Early detection of HCC is associated with better treatment outcomes and improved survival. International guidelines recommend 6-monthly surveillance of patients at risk of developing HCC. A nurse-led HCC surveillance protocol was established to support patients in adherence to surveillance protocols. The design used was retrospective document analysis. Retrospective analysis of healthcare records of patients referred to the clinic between August 2009 and December 2015. Extracted data included attendance of clinic visits, blood testing, ultrasound or other imaging, and outcomes. Ultrasound was attended within 6 months in 30.3% of cases and within 7 months in 71.2% of cases. The median time between Nurse-Led Clinic appointments, ultrasound scans and blood testing did not exceed 9 months. First year FibroScans were attended by 82.9% (63/76) patients; endoscopy was indicated for 42 and attended by 35 (83.3%) patients. Lesions were identified in 16 patients (21.5%) and HCC diagnosed in two patients. One patient died because of HCC and one to sub-dural haematoma. Nurse-led HCC surveillance was an effective method of monitoring patients with cirrhosis at high risk of developing HCC. Well-defined protocols enable timely identification of patients with HCC or hepatic decompensation so that management strategies can be implemented without delay. The potential benefits identified by this study warrant further, rigorous evaluation.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Saroj
authors.initials: S
authors.lastname: Nazareth
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Leembruggen
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Tuma
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Sook-Ling
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Samarth
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Kontorinis
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000451:nursing* / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D011159:Population Surveillance; D057184:Practice Patterns, Nurses'; D015397:Program Evaluation; D012189:Retrospective Studies
keywords: HCC screening; cirrhosis; hepatocellular carcinoma; nurse-led programme; surveillance