Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients

ARTICLE HIGHLIGHTS

Research background

Hepatocellular carcinoma (HCC) surveillance rates reported from the United States and Europe remain low, despite published clinical guideline recommendations. Surveillance patterns in Australia, which has the benefit a universal healthcare program, have not been clearly delineated.

Research motivation

Patients, and evaluate factors associated with greater uptake of HCC cancer screening. In incorporating both frequency of screening and quantity of imaging performed, we aimed to have a more continuous way of standardising ‘adherence’. Identification of determinants associated with higher HCC screening adherence aims to guide further areas for intervention.

Research objectives

As stated above, the objectives were characterising continuous HCC surveillance adherence. This method provides a way of standardising ‘adherence’, and thus allows for equal comparison between different studies evaluating the concept of HCC screening adherence.

Research methods

This was a retrospective cohort study that incorporated data electronic medical records to obtain patient demographics, clinical history, lab investigations and radiological imaging results. Data analysis was both on the univariate and multivariate level. In particular, quantile regression was performed for the non-parametric outcome variable, and provides greater description of covariate associations across the range of the outcome variable.

Research results

Follow-up of 775 at-risk patients demonstrated that median time-up-to-date with HCC surveillance was 84.2%. However, different patient factors, affected HCC surveillance adherence variably across different ranges of the outcome variable percentage of time up-to-date with HCC surveillance (PTUDS). At the 25^th quantile/percentile for PTUDS, older age was associated with greater HCC surveillance. At the 50^th quantile, African ethnicity had lower HCC surveillance. At the 75^th quantile, cirrhotic status was associated with greater adherence to surveillance. Those of culturally and linguistically diverse backgrounds had lower continuous HCC surveillance rates at both the 50^th and 75^th quantiles. The ramifications of these findings and identified determinants affecting HCC surveillance participation in other settings, including the primary care setting, are less clear. However, they remain very important areas for further research. In particular, addressing the impact of ethnicity and cultural and linguistic backgrounds on screening uptake may well have beneficial consequent effects in other areas of healthcare.

Research conclusions

The study suggests specific patient and systemic factors that contribute to participation in HCC surveillance. These factors include younger age, non-cirrhotic status, African ethnicity and coming from a culturally and linguistically diverse background, which all are variably associated with lower percentage of time up-to-date with HCC surveillance.

Research perspectives

Future research should be directed at determining interventions aimed at the factors identified in this study to be associated with reduced HCC screening adherence. Those that improve participation in HCC surveillance may well benefit from widespread implementation to improve earlier diagnosis of HCCs.