Integrative review: patient and provider factors related to hepatocellular carcinoma surveillance in patients with liver cirrhosis

Debra A. Guss, Smruti R. Mohanty


Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and the fifth most prevalent cancer worldwide, with cirrhosis being the main risk factor for the development of HCC. The American Association for Study of Liver Disease (AASLD) recommends surveillance of patients with cirrhosis for HCC using ultrasound (US) of the abdomen every 6 months as a cost-effective intervention to reduce mortality and improve survival. However, it is widely known that surveillance is not consistently completed, and the rates of HCC surveillance are very low. The purpose of this integrative review was to evaluate and summarize the available data related to provider and patient factors that are associated with surveillance and missed surveillance for HCC in patients with cirrhosis of the liver, and to recommend interventions to improve these rates of surveillance and subsequently improving survival in patients with cirrhosis.