title: Poor adherence and low persistency rates for hepatocellular carcinoma surveillance in patients with chronic hepatitis B.
abstract: Our goal was to examine rates and predictors for hepatocellular carcinoma (HCC) surveillance adherence and persistency, since studies of such adherence and persistency in patients with chronic hepatitis (CHB) are currently limited.Consecutive CHB patients (N = 1329) monitored for ≥1 year at 4 US clinics from January 1996 to July 2013 were retrospectively studied. Surveillance adherence was evaluated based on the American Association for the Study of Liver Diseases guidelines. Kaplan-Meier method was used to analyze surveillance persistency of 510 patients who had initially fair adherence (having at least annual surveillance imaging with further follow-up).Mean age was 48, with the majority being male (58%), Asian (92%), foreign-born (95%), and medically insured (97%). Patients with cirrhosis and those seen at university liver clinics were more likely to have optimal HCC surveillance than those without cirrhosis and those seen at community clinics (38.4% vs 21.6%, P <0.001 and 33.5% vs 14.4%, P < 0.001, respectively). HCC diagnosed in optimally adherent patients trended toward smaller tumor size (P < 0.08). On multivariate analysis also inclusive of age, sex, clinical visits, cirrhosis, clinic setting and antiviral therapy use, strong independent predictors for having at least annual imaging were a history of more frequent clinical visits (odds ratio [OR] = 2.5, P < 0.001) and university-based care (OR = 5.2, P < 0.001). Even for those with initially fair adherence, persistency dropped to 70% at 5 years.Adherence and persistency to HCC surveillance in CHB patients is generally poor. More frequent clinic visits and university-based settings were significant and strong predictors of at least annual HCC surveillance adherence.
authors: Public Policy Department, Stanford University, Stanford, CA Department of Medicine, Stanford University Medical Center, Palo Alto, CA Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA Department of Biology, Stanford University, Stanford, CA Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, P.R. China Department of Medicine, Yale University Medical Center, New Haven, CT Department of Medicine, University of California, San Diego Medical Center, San Diego, CA Department of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, CA Department of Outpatient Clinics, Chinese Hospital, San Francisco, CA San Jose Gastroenterology, San Jose, CA.
authors: Christina
authors: C
authors: Wang
authors: Vincent
authors: V
authors: Chen
authors: Vinh
authors: V
authors: Vu
authors: An
authors: A
authors: Le
authors: Linda
authors: L
authors: Nguyen
authors: Changqing
authors: C
authors: Zhao
authors: Carrie R
authors: CR
authors: Wong
authors: Nghia
authors: N
authors: Nguyen
authors: Jiayi
authors: J
authors: Li
authors: Jian
authors: J
authors: Zhang
authors: Huy
authors: H
authors: Trinh
authors: Mindie H
authors: MH
authors: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D055815:Young Adult