Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma and prolongs survival.
However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status.
Dr Amit Singal and colleagues from Texas, USA compared the effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for hepatocellular carcinoma in a racially diverse, and socioeconomically disadvantaged cohort.
The researchers performed a prospective study of patients with documented or suspected cirrhosis at a large safety-net health system from 2014 through 2016.
Patients were assigned randomly to groups that received mailed invitations for an ultrasound screening examination, mailed invitations for an ultrasound screening examination and patient navigation, or usual care.
|The team documented cirrhosis for 80% of patients|
Patients who did not respond to outreach invitations within 2 weeks received up to 3 reminder telephone calls.
The team's primary outcome was completion of abdominal imaging within 6 months of randomization.
Baseline characteristics were similar among groups.
The team documented cirrhosis, based on International Classification of Diseases, 9th revision, codes, for 80% of patients, and suspected, based on noninvasive markers of fibrosis, for 20%.
The researchers found significantly greater proportions of patients who received the mailed invitation and navigation or the mailed invitation alone underwent hepatocellular carcinoma screening than patients who received usual care.
However, the team noted that screening rates did not differ significantly between outreach the outreach groups.
The effects of the outreach program were consistent in all subgroups, including Caucasian vs non-Caucasian race, documented vs suspected cirrhosis, Child–Pugh A vs B cirrhosis, and receipt of gastroenterology care.
Dr Singal's team concludes, "In a prospective study, we found outreach strategies to double the percentage of patients with cirrhosis who underwent ultrasound screening for hepatocellular carcinoma."
"However, adding patient navigation to telephone reminders provided no significant additional benefit."