naVIGation Invitations Liver surveillANce upTake

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Despite advances in treatment options, prognosis remains worrying, with 5-year survival rates remaining less than 20%.

Surveillance for HCC involves six-monthly ultrasounds (US) of the liver and has been demonstrated to increase rate of early diagnosis, which translates to improved survival. However, the uptake of HCC surveillance is low internationally; in Western countries, only 20% of patients eligible for HCC surveillance receive a surveillance test.

The current provision of HCC surveillance in the UK is ad hoc: eligible patients have six-monthly ultrasound requested by their clinician (usually a gastroenterologist, hepatologist or hepatology clinical nurse specialist). Patients receive an ultrasound appointment in the post with no formal invitation or information about the surveillance test. Work with focus groups suggests lack of knowledge and fear are barriers to HCC surveillance attendance.

Previous research has shown that patient navigation increased HCC surveillance uptake in an American population. However, there has been no research on interventions aimed at improving surveillance uptake in the UK population.

The study predicts that the mailed invitations and Patient Navigators will improve patient attendance at HCC surveillance and increases the number of patients diagnosed with early-stage HCC, compared with usual care.

Inclusion criteria

• 18 years of age or older
• ECOG performance status of 0-2
• Eligible for HCC surveillance as defined by NICE and EASL criteria
• Child Pugh A or B cirrhosis
• Child Pugh C cirrhosis AND on liver transplant waiting list
• High risk chronic hepatitis B

Exclusion criteria

• Previous or current diagnosis of HCC
• Child Pugh C cirrhosis
• Frailty (Clinical Frailty Scale >7)
• Previous liver transplant