Evaluating hepatocellular carcinoma (HCC) surveillance through an early diagnostic centre: An implementation science...

Hepatocellular carcinoma (HCC) has high mortality, improved by early diagnosis. An integrated service was established to facilitate timely cancer surveillance.

Evaluate the utility of an early diagnostic centre (EDC) in diagnosis of liver cancer.

Retrospective analysis of patients at an EDC (2022-2024), compared to previous general clinic attendance. We investigated demographics, and liver disease aetiology and status. We tracked attendances and 'did-not-attend' rates, with sub-categorisation by time period. Assessments were categorised as ideal, optimal, sub-optimal or poor. Travel-costs and times were estimated.

Patients attending the centre (315) were reviewed, with previous clinic reviews serving as comparator. The cohort was predominantly male (58.1%), mean age 53.93 ± 11.75 years, British-African descent (20.3%), from deprived backgrounds (68.8%) and non-cirrhotic (53.3%). The leading liver disease aetiology was hepatitis B (54.3%), followed by hepatitis C (20.6%) and alcoholic liver disease (11.4%). The EDC had a lower 'did-not-attend' rate (15.70% vs. 23.97% in general clinics), higher proportion of ideal assessments (99.7% vs. 51.1%), lower 'did-not-attend' costs (£11,695 vs. £119,796) and lower patient travel time (461 vs. 655 h) and cost (£3,249 vs. £9,765). Sub-stratification by COVID time periods showed 55 attendance failures pre-COVID, 146 during COVID and 401 post-COVID; compared to 73 'did-not-attends' in the EDC.

The EDC demonstrated clinical and economic efficiencies, improved surveillance and a reduction in costs compared to traditional clinics. These results underscore the potential of this model to enhance HCC surveillance, reduce costs and improve compliance.