Publication date: Jul 15, 2023

The COVID-19 pandemic has profoundly disrupted preventative health care services including cancer screening. As the largest provider of cirrhosis care in the United States, the Veterans Affairs (VA) National Gastroenterology and Hepatology Program aimed to assess factors associated with hepatocellular carcinoma (HCC) stage at diagnosis, treatment, and survival. Veterans with a new diagnosis of HCC in 2021 were identified from electronic health records (n=2306). Structured medical record extraction was performed by expert reviewers in a 10% random sub-sample of Veterans with new HCC diagnoses. Factors associated with stage at diagnosis, receipt of treatment and survival were assessed using multivariable models. Among 199 patients with confirmed HCC, the average age was 71 and most (72%) had underlying cirrhosis. More than half (54%) were at early stage (T1 or T2) at diagnosis. Less advanced liver disease; number of imaging tests adequate for Hepatocellular Carcinoma screening (“HCC screening”); HCC diagnosis in VA; and receipt of VA primary care were significantly associated with early-stage diagnosis. HCC-directed treatments were administered to 145 (73%) patients after a median of 37 (IQR 19-54) days from diagnosis, including 70 (35%) receiving potentially curative treatments. Factors associated with potentially curative (versus no) treatments included: HCC screening, early-stage at diagnosis, and better performance status. Having fewer comorbidities and better performance status were significantly associated with non-curative (versus no) treatment. Early-stage diagnosis, diagnosis in the VA system, and receipt of curative treatment were significantly associated with survival. These results highlight the importance of HCC screening and engagement in care for HCC diagnosis, treatment, and survival while demonstrating the feasibility of developing a national quality improvement agenda for HCC screening, diagnosis, and treatment.

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