Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma.
Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma.
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DOI：
10.1016/j.cgh.2019.07.042
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发表时间：
2020-04
期刊：
影响因子：
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通讯作者：
Singal AG
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作者：
Rich NE;Yang JD;Perumalswami PV;Alkhouri N;Jackson W;Parikh ND;Mehta N;Salgia R;Duarte-Rojo A;Kulik L;Rakoski M;Said A;Oloruntoba O;Ioannou GN;Hoteit MA;Moon AM;Rangnekar AS;Eswaran SL;Zheng E;Jou JH;Hanje J;Pillai A;Hernaez R;Wong R;Scaglione S;Samant H;Kapuria D;Chandna S;Rosenblatt R;Ajmera V;Frenette CT;Satapathy SK;Mantry P;Jalal P;John BV;Fix OK;Leise M;Lindenmeyer CC;Flores A;Patel N;Jiang ZG;Latt N;Dhanasekaran R;Odewole M;Kagan S;Marrero JA;Singal AG
直接作用抗病毒药物（DAA）对丙型肝炎病毒有效，持续的病毒学应答与肝细胞癌（HCC）的发病率降低相关。然而，在活动性或治疗性HCC患者中使用DAA存在争议，并且这些患者的最佳管理不确定。我们的目的是描述美国肝病医生对肝癌患者使用DAA的态度和实践模式。我们对25个州的47个三级保健中心的肝病提供者进行了调查。我们向476家供应商发送了调查问卷，收到了279份回复（58.6%）。提供者对DAA治疗后HCC复发风险的信念各不相同：48%的人回答DAA降低风险，36%的人回答DAA不会改变风险，16%的人回答DAA增加HCC复发风险。然而，大多数提供者认为DAA有益于并降低对HCC治疗完全应答的患者的死亡率。因此，几乎所有的供应商（94.9%）报告建议DAA治疗的早期肝癌患者接受根治性治疗。然而，较少的供应商推荐DAA治疗中期（72.9%）或晚期（57.5%）肝癌患者接受姑息治疗。根据HCC治疗方式，不同医疗服务提供者启动DAA的时间不同：49.1%的医疗服务提供者报告他们将在手术切除后3个月内启动DAA治疗，而45.9%和5.0%的医疗服务提供者分别将DAA启动延迟3-12个月和>1年。对于接受经动脉化疗栓塞（TACE）的患者，42.0%的供应商将在手术后3个月内提供DAA，46.7%的供应商将延迟DAA至3-12个月后，11.3%的供应商将延迟DAA至TACE后1年以上。根据发送给肝病提供者的一项调查，关于HCC患者DAA的使用和时间，提供者的态度和实践模式存在差异。需要进一步的研究来描述DAA治疗在该患者人群中的风险和益处。
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. 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%). 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 responses 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. 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.