Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial
Open accessAbstract
Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival in patients with cirrhosis; however, effectiveness is limited by underuse. We compared the effectiveness of mailed outreach and patient navigation strategies to increase HCC surveillance in a racially diverse cohort of patients with cirrhosis. We conducted a pragmatic randomized clinical trial comparing mailed outreach for screening ultrasound (n = 600), mailed outreach plus patient navigation (n = 600), or usual care with visit‐based screening (n = 600) among 1800 patients with cirrhosis at a large safety‐net health system from December 2014 to March 2017. Patients who did not respond to outreach invitations within 2 weeks received reminder telephone calls. Patient navigation included an assessment of barriers to surveillance and encouragement of surveillance participation. The primary outcome was HCC surveillance (abdominal imaging every 6 months) over an 18‐month period. All 1800 patients were included in intention‐to‐screen analyses. HCC surveillance was performed in 23.3% of outreach/navigation patients, 17.8% of outreach‐alone patients, and 7.3% of usual care patients. HCC surveillance was 16.0% (95% confidence interval [CI]: 12.0%‐20.0%) and 10.5% (95% CI: 6.8%‐14.2%) higher in outreach groups than usual care (P < 0.001 for both) and 5.5% (95% CI: 0.9%‐10.1%) higher for outreach/navigation than outreach alone (P = 0.02). Both interventions increased HCC surveillance across predefined patient subgroups. The proportion of HCC patients detected at an early stage did not differ between groups; however, a higher proportion of patients with screen‐detected HCC across groups had early‐stage tumors than those with HCC detected incidentally or symptomatically (83.3% versus 30.8%, P = 0.003). Conclusion: Mailed outreach invitations and navigation significantly increased HCC surveillance versus usual care in patients with cirrhosis.
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The survey was limited by nonresponse bias, although the response rate is similar to those of similar mailed efforts.
“our survey was limited by nonresponse bias, although our response rate is similar to those of similar mailed efforts.”
From Depression and anxiety are common among patients with cirrhosis (2022) · cites this paper as [37]
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References 39 · Cited by 89
- Authors
- Singal, A. G., Tiro, J. A., Murphy, C. C., Marrero, J. A., McCallister, K., Fullington, H., Mejias, C., Waljee, A. K., Pechero Bishop, W., Santini, N. O., & Halm, E. A.
- Affiliations
- Parkland Health & Hospital System (US)
- Harold C. Simmons Comprehensive Cancer Center (US)
- The University of Texas Southwestern Medical Center (US)
- University of Michigan (US)
- Department of Clinical Sciences,The University of Texas Southwestern Medical Center,Dallas,Texas
- Corresponding author
- Singal, Amit G.
- ORCID
- Venue
- Hepatology
- Published
- 2018-12-14
- Volume
- 69
- Issue
- 1
- Pages
- 121-130
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC6324997
- OpenAlex
- W2886194374
- Cited by
- 89
- References
- 39
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 16 · 2023: 12 · 2022: 8 · 2021: 11 · 2020: 18 · 2019: 9
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Cancer Prevention and Research Institute of Texas (RP150587)
- National Institutes of Health (RP150587)
- Agency for Healthcare Research and Quality (P30 CA142543, HS022418, R24HS022418, NIH RO1 CA212008)
- National Cancer Institute (R24 HS022418, RP150587, RO1CA212008, R01CA212008, (CA142543), P30CA142543)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- HCC surveillance, liver cirrhosis, patient navigation, early cancer detection, safety-net health system
- MeSH terms
- Adult, Aged, Aged, 80 and over, Double-Blind Method, Female, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Male, Middle Aged, Population Surveillance, Postal Service, Ultrasonography, Early Detection of Cancer, Young Adult
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