[Abstract #390] Understanding practices and gaps in multidisciplinary hepatocellular carcinoma (HCC) care within the community oncology setting

Presenters

Lorna Lucas, MSM1, Philip A. Philip, MD, PhD, FRCP2, Marianne Gandee, BS, MA1, & Amanda Kramar1
1Association of Cancer Care Centers, Rockville, MD, USA; 2Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

Background

HCC incidence continues to rise and presents a myriad of complex challenges involving multi disciplines to screen, diagnose, and provide personalized therapy. Recent advances in diagnostics and therapies necessitate a well-coordinated multidisciplinary approach in managing HCC patients, signaling a need to understand care within community care. The study aimed to understand how multidisciplinary cancer programs were structured to manage HCC care and to identify challenges and practices for management of HCC, a cancer less commonly seen in community care settings.

Methods

The Association of Cancer Care Centers (ACCC) developed a survey to identify factors associated with delivery and coordination of care for HCC patients. The survey deployed electronically in July 2018 to multidisciplinary providers, representing 17 oncology professions. Of responses (n = 31), 69% identified their care setting as a “non-teaching community hospital, freestanding cancer center, private practice or other.”

Results

61% of respondents indicated their cancer programs do not have specialized hepatobiliary multidisciplinary team. Among those who have hepatobiliary multidisciplinary teams the composition and degree of specialization varied. 85% of respondents that do not have a specialized hepatobiliary team indicated that HCC patients are managed in consultation with a general tumor board. 52% indicated their program discussed participation in clinical trials with all HCC patients, and 55% of cancer programs conducted HCC clinical trials. 52% indicated their program had a formal pathway that outlines adherence to the NCCN guidelines for HCC management, 5% were in the process of developing and 43% were not in the process of developing such a pathway. Of respondents that reported barriers their program faces (n = 13) 31% indicated lack of psychosocial services, lack of screening and no/limited access to clinical trials. 23% responded delayed treatment and 15% responded delayed diagnosis as challenges.

Conclusions

Review of multidisciplinary care delivery for HCC patients revealed unique protocols and challenges within primarily community-based settings.