医学
外展
肝细胞癌
内科学
随机对照试验
肝硬化
临床试验
阶段(地层学)
家庭医学
物理疗法
儿科
政治学
法学
古生物学
生物
作者
Amit G. Singal,Manasa Narasimman,Darine Daher,Sruthi Yekkaluri,Yan Liu,MinJae Lee,Vanessa Cerda,Aisha Khan,Karim Seif El Dahan,Jennifer R. Kramer,Purva Gopal,Caitlin C. Murphy,Rubén Hernáez
出处
期刊:Gut
[BMJ]
日期:2024-06-05
卷期号:: gutjnl-332508
被引量:2
标识
DOI:10.1136/gutjnl-2024-332508
摘要
Background Hepatocellular carcinoma (HCC) is plagued by failures across the cancer care continuum, leading to frequent late-stage diagnoses and high mortality. We evaluated the effectiveness of mailed outreach invitations plus patient navigation to promote HCC screening process completion in patients with cirrhosis. Methods Between April 2018 and September 2021, we conducted a multicentre pragmatic randomised clinical trial comparing mailed outreach plus patient navigation for HCC screening (n=1436) versus usual care with visit-based screening (n=1436) among patients with cirrhosis at three US health systems. Our primary outcome was screening process completion over a 36-month period, and our secondary outcome was the proportion of time covered (PTC) by screening. All patients were included in intention-to-screen analyses. Results All 2872 participants (median age 61.3 years; 32.3% women) were included in intention-to-screen analyses. Screening process completion was observed in 6.6% (95% CI: 5.3% to 7.9%) of patients randomised to outreach and 3.3% (95% CI: 2.4% to 4.3%) of those randomised to usual care (OR 2.05, 95% CI: 1.44 to 2.92). The intervention increased HCC screening process completion across most subgroups including age, sex, race and ethnicity, Child-Turcotte-Pugh class and health system. PTC was also significantly higher in the outreach arm than usual care (mean 37.5% vs 28.2%; RR 1.33, 95% CI: 1.31 to 1.35). Despite screening underuse, most HCC in both arms were detected at an early stage. Conclusion Mailed outreach plus navigation significantly increased HCC screening process completion versus usual care in patients with cirrhosis, with a consistent effect across most examined subgroups. However, screening completion remained suboptimal in both arms, underscoring a need for more intensive interventions. Trial registration number NCT02582918 .
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