PHILADELPHIA — How did the first two years of the COVID-19 pandemic affect hepatocellular carcinoma (HCC) surveillance and factors associated with completion at the VA?
Researchers from the Perelman School of Medicine at the University of Pennsylvania and the Corporal Michael J. Crescenz VAMC, both in Philadelphia, sought to find out. To do so, they analyzed longitudinal trends in mortality, outpatient and inpatient care for cirrhosis in a national veteran cohort.
In the report published in the American Journal of Gastroenterology, data were gathered on mortality, outpatient primary care provider, gastroenterology/hepatology (GI/HEP) visits and hospitalizations. Data came from 68,073 patients within the VA’s national cirrhosis cohort from 2020 to 2021; 28,678 were eligible for HCC surveillance, which researchers computed as a percentage of time up to date with surveillance every 6 months (PTUDS).1
Results indicated that outpatient primary care provider and GI/HEP appointment rates initially dropped from 30% to 7% but rebounded within one year into the pandemic, and use remained steady.
“Telemedicine monthly visit rates rose from less than 10% to a peak of 20% with a steady gradual decline,” the authors wrote. “Nearly 70% of veterans were up-to-date with HCC surveillance before the pandemic, with an early pandemic nadir of approximately 50% and 60% PTUDS 2 years into the pandemic.”
In adjusted models, the study team determined that the use of a population-based cirrhosis dashboard (β 8.5, 95% CI 6.9-10.2) and GI/HEP visits both in-person (β 3.2, 95% CI 2.9-3.6) and telemedicine (β 2.1, 95% CI 1.9-2.4) were associated with a higher PTUDS.
“Outpatient utilization and HCC surveillance rates have rebounded but remain below at baseline,” the researchers concluded. “Population-based approaches and specialty care for cirrhosis were associated with a higher completion of HCC surveillance.”
- Serper M, Tapper EB, Kaplan DE, Taddei TH, Mahmud N. Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic. Am J Gastroenterol. 2023 Feb 1;118(2):294-303. doi: 10.14309/ajg.0000000000002011