1UNC Liver Center, Division of Gastroenterology and Hepatology, Burnett-Womack Bldg., Room 8011, Chapel Hill, NC 27599-7584.
2H. W. Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, CB# 3355, 231D Davis Library, Chapel Hill, NC 27599-3355.
3UNC Liver Center, Division of Gastroenterology and Hepatology, Burnett-Womack Bldg., Room 8011, Chapel Hill, NC 27599-7584. Electronic address: firstname.lastname@example.org.
BACKGROUND & AIMS:
A large proportion of patients with cirrhosis are seen only by their primary care provider (PCP). Surveillance for hepatocellular carcinoma (HCC) therefore depends on PCPs in these cases. We aimed to assess PCP knowledge and practice of HCC surveillance.
We contacted a random sample of 1000 North Carolina PCPs by mail. All received an introductory letter, followed by a 12-item questionnaire addressing HCC surveillance knowledge and practice.
Three hundred ninety-one PCPs (39%) completed the survey; 89% saw patients with cirrhosis in their practice, but only 45% screened for HCC. Among PCPs who screened, the most common methods were ultrasound analysis and measurement of α fetoprotein (66%). Reasons for surveillance included supported by evidence (72%), recommended by medical societies (42%), and malpractice liability for not surveilling (26%). Of PCPs who did not screen, 84% referred to gastroenterologists for surveillance decisions, 24% were unaware of recommendations, 8% were uncertain of the benefits, and 8% were concerned over cost. Hepatic resection and liver transplantation were identified as effective therapies by 67% and 56% of PCPs, but all other effective therapies were identified by less than half (transarterial chemoembolization by 42%, radiofrequency ablation by 35%, sorafenib by 26%). Ability to identify at least 1 effective therapy was independently associated with surveillance (odds ratio, 2.1; 95% confidence interval, 1.1-4.0)
CONCLUSIONS: Most PCPs see patients with cirrhosis, but only a minority screen for HCC. PCP knowledge of effective HCC therapy options is suboptimal. Efforts to enlist PCPs in HCC surveillance may be best served by increasing their knowledge of effective therapies.