P2357 - Hepatocellular Carcinoma Surveillance at G.V. Sonny Montgomery VA Medical Center: How Well Are We Really Doing?

Nathan Usry, MD, Benjamin Billingsley, DO, Hilary Elom, MD, Anna Lauren G. Winter, MD, Kaitlyn Cronk, MD, Elizabeth Paine, MD
University of Mississippi Medical Center, Jackson, MS

Introduction: Globally, cancer of the liver and intrahepatic bile ducts is the sixth most frequently diagnosed cancer. The main risk factor for the development of hepatocellular carcinoma (HCC) is cirrhosis, present in >80% of individuals affected by HCC. Currently, the American Association for the Study of Liver Diseases (AASLD) and the National Comprehensive Cancer Network (NCCN) recommend screening for HCC with abdominal ultrasound with or without alpha-fetoprotein every six months in all adults with cirrhosis to increase the detection of early staged tumors and survival.

Methods: This is a retrospective study of patients diagnosed with cirrhosis at the VA Hospital in Jackson, MS. We initially used clinical data from EHR through 3/6/2022 to evaluate patients with cirrhosis. Medical records were reviewed, and preliminary analysis was done using a Microsoft Excel analyzer. After initial retrospective analysis, further records were reviewed in the same manner in CPRS using data from 8/5/2022 through 4/5/2023 to evaluate statistical changes in adherence after implementation of nation-wide VA provider reminder order-set.

Results: Out of 173 patients found to have cirrhosis in initial date review, only 78 (45.1%) had their HCC screening in the last 6 months relative to study while 95 (54.9%) had their screening overdue. Of the 95 patients overdue for screening, 1(1%) patient was reported deceased while another 1(1%) patient declined further imaging.

Further analysis based on the same criteria was performed after August 5th, 2022 through April 5th, 2023 for an analysis of 109 total patients. Of those patients, 16 had no true diagnosis of cirrhosis per latest imaging, 3 had been diagnosed with hepatocellular carcinoma, and 3 had undergone orthotopic liver transplantations. 87 patients fit criteria for analysis. Of the 87 individuals, 70 patients (80.5%) were considered to be up to date with screening per guidelines mentioned and 17 (19.5%) were not.

Discussion: On 8/5/2023, the National Gastroenterology and Hepatology Program in conjunction with the Veterans Affairs hospital conglomerate initiated a reminder for providers to screen those with cirrhosis. Initial data proved adherence to HCC screening as generally poor with an adherence rate of 45.1%, similar to the rate in other VA facilities across the country. Since implementation of EHR reminders at a national level for the VA network, we found that rates of compliance with appropriate screening were dramatically increased to 80.5%.



Disclosures:


Nathan Usry, MD, Benjamin Billingsley, DO, Hilary Elom, MD, Anna Lauren G. Winter, MD, Kaitlyn Cronk, MD, Elizabeth Paine, MD. P2357 - Hepatocellular Carcinoma Surveillance at G.V. Sonny Montgomery VA Medical Center: How Well Are We Really Doing?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.