Evaluating hepatocellular carcinoma (HCC) surveillance through an early diagnostic centre: An implementation science approach at a tertiary hepatology centre in England

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) has high mortality, improved by early diagnosis. An integrated service was established to facilitate timely cancer surveillance. AIMS: Evaluate the utility of an early diagnostic centre (EDC) in diagnosis of liver cancer. METHODS: Retrospective analysis of patients at an EDC (2022-2024), compared to previous general clinic attendance. We investigated demographics, and liver disease aetiology and status. We tracked attendances and 'did-not-attend' rates, with sub-categorisation by time period. Assessments were categorised as ideal, optimal, sub-optimal or poor. Travel-costs and times were estimated. RESULTS: Patients attending the centre (315) were reviewed, with previous clinic reviews serving as comparator. The cohort was predominantly male (58.1%), mean age 53.93 ± 11.75 years, British-African descent (20.3%), from deprived backgrounds (68.8%) and non-cirrhotic (53.3%). The leading liver disease aetiology was hepatitis B (54.3%), followed by hepatitis C (20.6%) and alcoholic liver disease (11.4%). The EDC had a lower 'did-not-attend' rate (15.70% vs. 23.97% in general clinics), higher proportion of ideal assessments (99.7% vs. 51.1%), lower 'did-not-attend' costs (£11,695 vs. £119,796) and lower patient travel time (461 vs. 655 h) and cost (£3,249 vs. £9,765). Sub-stratification by COVID time periods showed 55 attendance failures pre-COVID, 146 during COVID and 401 post-COVID; compared to 73 'did-not-attends' in the EDC. CONCLUSION: The EDC demonstrated clinical and economic efficiencies, improved surveillance and a reduction in costs compared to traditional clinics. These results underscore the potential of this model to enhance HCC surveillance, reduce costs and improve compliance.