SAT-441-YI Who doesn’t turn up? Exploring patient characteristics associated with non-adherence with regular hepatocellular carcinoma surveillance: a systematic review and meta-analysis

MacCarthy, Hannah, Buchanan, Ryan M., Böhning, Dankmar and Glyn-Owen, Kate (2024) SAT-441-YI Who doesn’t turn up? Exploring patient characteristics associated with non-adherence with regular hepatocellular carcinoma surveillance: a systematic review and meta-analysis. Journal of Hepatology, 80. (doi:10.1016/s0168-8278(24)01863-4).

Abstract

Background and aims: in 2020, hepatocellular carcinoma (HCC) was the sixth most diagnosed cancer and had the third highest mortality globally. Five-year survival is around 18%, stressing the importance of routine six-monthly surveillance, which increases the likelihood of early detection and receipt of curative treatment. Surveillance adherence is around 52%. HCC disproportionately affects socioeconomically deprived and under-served groups, and these groups also have low uptake of population screening programmes. We aimed to explore characteristics associated with non-adherence with
regular surveillance for HCC.

Method: this study updated a previous systematic review and meta analysis of HCC patients, to include recent studies and to explore alternative outcomes in relation to attendance at regular surveillance. Ovid and Embase databases were searched from July 2020-November 2023, in addition to the original searches from January 2014. We included cohort studies of patients with diagnosed HCC, which reported data on prior attendance in a surveillance programme. Data
were extracted on attendance, sociodemographic characteristics, risk
factors for liver disease and underlying aetiology of disease. Data were analysed using STATA, meta-analysis was conducted where appropriate and sensitivity analyses were conducted excluding studies with high risk of bias. Likelihood of surveillance attendance was reported using odds ratios with 95% confidence intervals (CI).

Results: overall, 36 studies with a total of 1, 398, 994 HCC patients were included in the meta-analysis. Of these, 51.6% attended regular surveillance, and 48.4% did not. Male patients had significantly lower odds of attending surveillance compared to females (OR = 0.73, 95% CI 0.66–0.82). Former and current smokers had significantly lower odds of attending surveillance compared to non-smokers (OR = 0.79, 95% CI 0.68–0.92). Patients with HBV had significantly lower odds of
attending regular surveillance compared to patients with HCV (OR = 0.62, 95% CI 0.50–0.77). Patients with HCV also had significantly higher odds of attending regular surveillance when compared against other aetiologies (OR = 2.34, 95% CI 1.84–2.96). Patients with MASLD had significantly lower odds of attending surveillance when compared with other aetiologies (OR = 0.62, 95% CI 0.43–0.91).

Conclusion: amongst patients with a diagnosis of HCC, the following were less likely to have been attending a regular HCC surveillance programme: Male patients, patients with HBV or MASLD and current/ former smokers. This suggests potential targets for interventions aiming to increase surveillance uptake. More research is required to understand why these groups are not attending compared to other groups, such as those with HCV

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Contributors

Author: Dankmar Böhning

Author: Kate Glyn-Owen

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