SOURCE: Patel N, et al. Diagnostic delays are common among patients with hepatocellular carcinoma. J Natl Compr Canc Netw 2015;13:543-549.
Hepatocellular carcinoma (HCC) is the third-leading cause of cancer mortality worldwide. It is increasing in the United States, paralleling the rise in non-alcoholic fatty liver disease and hepatitis C. When diagnosed early, 5-year survival is as high as 70%, but diminishes to less than 1-year survival when diagnosed at an advanced stage.
Cirrhosis patients have been suggested to undergo ultrasound screening twice yearly, but not only does this process have only modest sensitivity (32%) it often is not followed by clinicians (or patients). Since 40% of HCC cases present with no previously recognized signs of liver disease, it becomes easier to understand how cases go “under the radar.”
Patel et al studied cases of HCC (n = 457) that presented to a large hospital and its affiliated primary care clinics in Dallas, TX, between 2005 and 2012. Almost half of the patients had received the HCC diagnosis as inpatients, which was associated with a very short lag time between presentation and diagnosis (< 1 week).
For those diagnosed as outpatients (n = 226), the delay from presentation to diagnosis was substantial. For instance, almost 40% of HCC diagnosed among outpatients incurred a 3-month delay from time of presentation, an interval that has been associated with meaningful disease progression. Healthcare sites that employed an electronic medical record showed less diagnostic delay. There was also a patient-dependent role in diagnostic delay, wherein some patients did not follow up recommended return visits, an occurrence more common among patients with hepatic encephalopathy. The authors encourage timely identification and follow-up of persons at-risk for HCC.