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Mail outreach doubles HCC screening in safety-net hospital
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Mail outreach strategies were effective for increasing screening rates for hepatocellular carcinoma among patients with cirrhosis, a population most at-risk, according to data from a recent prospective study.
“Our study is one of the first interventions to improve liver cancer screening and early detection among at-risk patients,” Amit G. Singal, MD, MS, Dedman Scholar of Clinical Care, division of digestive and liver diseases, University of Texas Southwestern, said in a press release. “The vulnerable patient population we studied in our safety-net health system are those who are at highest risk of dying from liver cancer, so this intervention helped those who might benefit the most.”
To determine how effective mailed outreach strategies, with and without patient navigation, are for HCC screening, Singal and colleagues enrolled 1,800 patients with proven (79.6%) or suspected cirrhosis (20.4%) seen at Parkland Health and Hospital System — the sole safety-net provide for Dallas County — between December 2014 and March 2016.
Researchers randomly divided the patients into three groups: patients who received mailed invitations for an ultrasound screening examination (n = 600); patients who received mailed invitations for an ultrasound screening examination and patient navigation (n = 600); and normal visit-based screening (without mail invitation; n = 600).
Patients who did not respond to outreach invitations within 2 weeks received up to three reminder telephone calls. The primary outcome of the study was abdominal imaging within 6 months of baseline.
In an intent-to-treat analysis, more patients who received the mailed invitation and navigation (47.2%) or the mailed invitation alone (44.5%) underwent screening for HCC compared with patients who received usual care (24.3%; P < .001 for both comparisons); however, the screening rates were not significantly different between the two outreach groups (P = .25).
The effects of the outreach program were consistent in all pre-defined subgroups: white vs. non-white race, documented vs. suspected cirrhosis, type of cirrhosis and receipt of gastroenterology care, according to the research.
Completion of ultrasound screening was directly related to outreach efforts in 55.7% of outreach-only patients and 58.8% of outreach and navigation patients. Although, adding patient navigation to telephone reminders provided no significant additional benefit.
“Our new study presents a model of a proactive, population health outreach strategy that can improve liver cancer screening and early detection among those at highest risk of adverse outcomes,” study researcher Ethan Halm, MD, director of the Center for Patient-Centered Outcomes Research, University of Texas Southwestern, said in the release.
Although mail outreach strategies were effective, HCC screening in both outreach groups remained below 50%.
“[This highlights] the need for more intensive interventions,” the researchers wrote. – by Melinda Stevens
Disclosures: Singal reports being a speaker for Bayer Pharmaceutical and has received grant funding from Gilead Sciences. All other researchers report no relevant financial disclosures.