TY - JOUR
T1 - Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma
AU - Rich, Nicole E.
AU - Yang, Ju Dong
AU - Perumalswami, Ponni V.
AU - Alkhouri, Naim
AU - Jackson, Whitney
AU - Parikh, Neehar D.
AU - Mehta, Neil
AU - Salgia, Reena
AU - Duarte-Rojo, Andres
AU - Kulik, Laura
AU - Rakoski, Mina
AU - Said, Adnan
AU - Oloruntoba, Omobonike
AU - Ioannou, George N.
AU - Hoteit, Maarouf A.
AU - Moon, Andrew M.
AU - Rangnekar, Amol S.
AU - Eswaran, Sheila L.
AU - Zheng, Elizabeth
AU - Jou, Janice H.
AU - Hanje, James
AU - Pillai, Anjana
AU - Hernaez, Ruben
AU - Wong, Robert
AU - Scaglione, Steven
AU - Samant, Hrishikesh
AU - Kapuria, Devika
AU - Chandna, Shaun
AU - Rosenblatt, Russell
AU - Ajmera, Veeral
AU - Frenette, Catherine T.
AU - Satapathy, Sanjaya K.
AU - Mantry, Parvez
AU - Jalal, Prasun
AU - John, Binu V.
AU - Fix, Oren K.
AU - Leise, Michael
AU - Lindenmeyer, Christina C.
AU - Flores, Avegail
AU - Patel, Nayan
AU - Jiang, Z. Gordon
AU - Latt, Nyan
AU - Dhanasekaran, Renumathy
AU - Odewole, Mobolaji
AU - Kagan, Sofia
AU - Marrero, Jorge A.
AU - Singal, Amit G.
N1 - Publisher Copyright:
© 2020 AGA Institute
PY - 2020/4
Y1 - 2020/4
N2 - Background & Aims: Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. Methods: We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). Results: Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3–12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3–12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. Conclusions: Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.
AB - Background & Aims: Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. Methods: We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). Results: Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3–12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3–12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. Conclusions: Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.
KW - Drug
KW - HCV
KW - Liver Cancer
KW - TACE
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UR - http://www.scopus.com/inward/citedby.url?scp=85081906841&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2019.07.042
DO - 10.1016/j.cgh.2019.07.042
M3 - Article
C2 - 31357028
AN - SCOPUS:85081906841
SN - 1542-3565
VL - 18
SP - 974
EP - 983
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 4
ER -