Supplementary Material for: Factors Influencing Surveillance for Hepatocellular Carcinoma in Patients with Liver Cirrhosis

Objective: Hepatocellular carcinoma (HCC) is the second
most common cause of cancer-related mortality worldwide, and a rising
cause of cancer mortality in the U.S. Liver cirrhosis is the major risk
factor for HCC. Surveillance of persons with cirrhosis facilitates early
detection and improves outcomes. We assessed the surveillance rate for
HCC within a major academic health system and identified factors
influencing surveillance. Patients and Methods: We
examined the surveillance rate for HCC using liver ultrasound, CT, or
MRI, and factors influencing surveillance in a cohort of 369 Minnesota
residents with cirrhosis seen at the Mayo Clinic between 2007 and 2009. Results:
Ninety-three percent of cirrhosis patients received at least one
surveillance study, but only 14% received the recommended uninterrupted
semiannual surveillance. Thirty percent received ≥75% of recommended
surveillance, and 59% received ≥50% of recommended surveillance. Factors
increasing surveillance included gastroenterology or hepatology
specialist visits (p < 0.0001), advanced liver disease as assessed by
hepatic encephalopathy (p = 0.0008), and comorbid illness as assessed
by diabetes mellitus (p = 0.02). Age, sex, race, residence, cirrhosis
etiology, or number of primary care visits did not significantly affect
the rate of surveillance. Conclusions: While the rate of
surveillance in a major academic health system was higher than reported
in other studies, surveillance was heavily dependent on visits to a
subspecialist. This suggests a major and urgent national need to improve
identification of individuals at risk for HCC in the primary care
setting and the initiation and maintenance of surveillance by primary
care practitioners.