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Grant Details

Grant Number: 5R01CA125487-03 Interpret this number
Primary Investigator: El-Serag, Hashem
Organization: Baylor College Of Medicine
Project Title: Surveillance for Hepatocellular Carcinoma Among Hcv-Infected Veterans
Fiscal Year: 2009
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Abstract

DESCRIPTION (provided by applicant): The incidence of hepatocellular carcioma (HCC) has doubled in the United States over the past two decades. Hepatitis C is the major risk factor for HCC with approximately 3 million individuals currently infected nationwide. Survival following HCC diagnosis is dismal except where potentially curative therapy (resection, transplant, local ablation) is applied. HCC surveillance is aimed at applying abdominal ultrasound and serum alpha-fetoprotein for diagnosing HCC at an early stage when patients are most likely to be eligible for potentially curative therapy. One randomized controlled trial and several cohort studies have indicated that HCC surveillance is associated with significantly improved survival. Practice guidelines have recommended HCC surveillance for patients with hepatitis C at high risk of developing HCC. However, there is a paucity of data evaluating the extent of prevalence, patterns, and determinants of HCC surveillance. AIMS: (i) To examine the patterns (prevalence, type, and frequency) of utilization of HCC surveillance in veterans infected with hepatitis C; (2) To examine patient-, facility provider-, and physician provider- determinants of HCC surveillance among veterans infected with hepatitis C; and (3) To examine the effect of HCC surveillance on the receipt of HCC potentially curative therapy and survival among veterans infected with hepatitis C, and to identify surveillance strategies associated with best outcomes. METHODS: We propose to conduct i) a retrospective cohort study of more than 150,000 patients infected with hepatitis C and 39,000 high-risk patients identified from the Department of Veterans Affairs Hepatitis C Registry, 2) a survey of more than 128 provider facilities to supplement information in the registry, and 3) a survey of physician providers to assess their knowledge and attitudes towards HCC surveillance. Surveillance tests will be identified in the registry based on a previously developed algorithm using data from administrative files. Patient-, tumor-, and facility determinants of HCC surveillance will be identifed from the Hepatitis C Registry and supplemented by the facility survey. Additionally, we will examine the association between surveillance and receipt of resection, transplant, or local ablation as well as survival. Hierarchical multivariable logistic regression and Cox proportional hazards modeling will be used to examine these outcomes. IMPACT: This study will examine a previously unaddressed subject pertaining to a highly fatal cancer that thus far has received little attention. It will provide information on the effectiveness of HCC screening as reflected by the extent of use as well as outcomes. Evaluating the extent and patterns of HCC surveillance is crucial in understanding diffusion (and obstacles) of this practice and in designing interventions to improve the implementation of HCC surveillance.

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Publications

Epidemiology of Hepatocellular Carcinoma in the United States: Where Are We? Where Do We Go?
Authors: El-Serag HB, Kanwal F
Source: Hepatology, 2014 May 17;null, p. null.
EPub date: 2014 May 17.
PMID: 24839253
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A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis.
Authors: El-Serag HB, Kanwal F, Davila JA, Kramer J, Richardson P
Source: Gastroenterology, 2014 May;146(5), p. 1249-55.e1.
EPub date: 2014 Jan 23.
PMID: 24462733
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Hepatocellular carcinoma screening practices in the Department of Veterans Affairs: findings from a national facility survey.
Authors: El-Serag HB, Alsarraj A, Richardson P, Davila JA, Kramer JR, Durfee J, Kanwal F
Source: Dig Dis Sci, 2013 Nov;58(11), p. 3117-26.
EPub date: 2013 Jul 19.
PMID: 23868438
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Epidemiology of hepatocellular carcinoma: consider the population.
Authors: Mittal S, El-Serag HB
Source: J Clin Gastroenterol, 2013 Jul;47 Suppl, p. S2-6.
PMID: 23632345
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Prevalence and predictors of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients.
Authors: Tyson GL, Kramer JR, Duan Z, Davila JA, Richardson PA, El-Serag HB
Source: Hepatology, 2013 Aug;58(2), p. 538-45.
EPub date: 2013 Jul 1.
PMID: 23505059
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Determinants of serum alpha-fetoprotein levels in hepatitis C-infected patients.
Authors: Richardson P, Duan Z, Kramer J, Davila JA, Tyson GL, El-Serag HB
Source: Clin Gastroenterol Hepatol, 2012 Apr;10(4), p. 428-33.
EPub date: 2011 Dec 7.
PMID: 22155556
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Level of ?-fetoprotein predicts mortality among patients with hepatitis C-related hepatocellular carcinoma.
Authors: Tyson GL, Duan Z, Kramer JR, Davila JA, Richardson PA, El-Serag HB
Source: Clin Gastroenterol Hepatol, 2011 Nov;9(11), p. 989-94.
EPub date: 2011 Aug 4.
PMID: 21820396
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Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA.
Authors: El-Serag HB, Kramer JR, Chen GJ, Duan Z, Richardson PA, Davila JA
Source: Gut, 2011 Jul;60(7), p. 992-7.
EPub date: 2011 Jan 21.
PMID: 21257990
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Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States.
Authors: Davila JA, Henderson L, Kramer JR, Kanwal F, Richardson PA, Duan Z, El-Serag HB
Source: Ann Intern Med, 2011 Jan 18;154(2), p. 85-93.
PMID: 21242365
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Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection.
Authors: Kanwal F, Hoang T, Kramer JR, Asch SM, Goetz MB, Zeringue A, Richardson P, El-Serag HB
Source: Gastroenterology, 2011 Apr;140(4), p. 1182-1188.e1.
EPub date: 2010 Dec 22.
PMID: 21184757
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Surveillance for hepatocellular carcinoma: development and validation of an algorithm to classify tests in administrative and laboratory data.
Authors: Richardson P, Henderson L, Davila JA, Kramer JR, Fitton CP, Chen GJ, El-Serag HB
Source: Dig Dis Sci, 2010 Nov;55(11), p. 3241-51.
EPub date: 2010 Sep 16.
PMID: 20844957
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Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States.
Authors: Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, El-Serag HB
Source: Hepatology, 2010 Jul;52(1), p. 132-41.
PMID: 20578139
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Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection: A population-based study of U.S. veterans.
Authors: El-Serag HB, Engels EA, Landgren O, Chiao E, Henderson L, Amaratunge HC, Giordano TP
Source: Hepatology, 2009 Jan;49(1), p. 116-23.
PMID: 19085911
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