Cirrhosis (liver disease) patients are at high risk to develop liver
cancer, which is increasing in frequency an average of 3% annually and has a five-year overall survival rate of just 17.5%.
Proactive outreach to cirrhosis patients in a safety net health
system successfully doubled their screening rates for liver cancer, revealed UT
Southwestern Medical Center researchers.
‘A proactive, population health outreach strategy can improve liver cancer screening and early detection among cirrhosis patients.’
"Finding ways to reach patients at high risk of liver cancer is
critical. Liver cancer has the fastest increasing mortality rate among
solid tumors in the U.S.," said first author Dr. Amit G. Singal, Associate Professor of Internal Medicine and Clinical Sciences, and a member of the Harold C. Simmons Comprehensive Cancer Center. "This high mortality is primarily due to low rates of liver cancer screening and high rates of late-stage diagnosis."
The study randomly divided 1,800 cirrhosis patients at Parkland
Health & Hospital System in Dallas into three groups. The first
group received mailed outreach invitations for screening ultrasound. The
second group received similar outreach plus patient navigation, and the
third received their usual care. Researchers learned that the group
receiving mailed outreach invitations were most likely to schedule an
ultrasound, which doubled the overall rate of screening.
The study appears in the journal Gastroenterology
"Our study is one of the first interventions to improve liver cancer
screening and early detection among at-risk patients. The vulnerable
patient population we studied in our safety net health system are those
who are at highest risk of dying from liver cancer, so this intervention
helped those who might benefit the most," said Dr. Singal.
Only one-fourth of patients with cirrhosis in routine care are
currently screened every six months for liver cancer with an ultrasound
as recommended by national guidelines. Symptoms are not usually present
when the cancer is in its early stages.
"Our research previously demonstrated that liver cancer screening is
underused in clinical practice, with lower rates of screening among
racial/ethnic minorities and socioeconomically disadvantaged patients,"
said senior author Dr. Ethan Halm, Director of the Center for Patient-Centered Outcomes Research,
Chief of the William T. and Gay F. Solomon Division of General Internal
Medicine, and Professor of Internal Medicine and Clinical Sciences.
"Our new study presents a model of a proactive, population health
outreach strategy that can improve liver cancer screening and early
detection among those at highest risk of adverse outcomes." Dr. Halm
holds the Walter Family Distinguished Chair in Internal Medicine in
Honor of Albert D. Roberts.
According to the National Cancer Institute, liver cancer is diagnosed
in an estimated 39,230 people annually. In 2013, there were an
estimated 54,954 people living with this cancer in the U.S. Risk factors
include a diagnosis of fatty liver disease, hepatitis B, hepatitis C,
cirrhosis, or a combination of these diseases.