HCC SURVEILLANCE IN A NURSE-LED CLINIC: ASSESSING ADHERENCE TO GUIDELINES AND POSSIBLE ROLE OF AMAP SCORE

ABSTRACT

Introduction NICE guidelines (2017) recommend offering 6 monthly surveillance with USS for all cirrhotic patients with exception for patients identified for end of life care. But surveillance intervals are often missed where care is delivered through Consultant-led clinics. Having introduced a nurse-led stable cirrhosis clinic in 2016, we assessed whether the recommended interval was being achieved, and what impact the 'aMAP' score stratifying annual HCC risk as low(<0.2%), medium( 1%) and high(4%) might have on service utilisation. Methods A retrospective review of all patients attending our nurse-led stable cirrhosis clinic. Review included demographic data, aetiology of liver disease, calculation of Child and aMAP (age, gender, albumin-bilirubin) scores using parameters from initial clinic visits. We assessed adherence to the twice yearly US scan since our adaptation of NICE guidelines in 2018. Results Between 2016-2018, 117(49 female) cirrhotic patients were enrolled in the clinic. Majority of the patients had ALD (55) and NASH(24). Other aetiologies included HCV, HFE and PBC. All patients had Child A disease except 7 with Child B (B73;B84). 13/117 patients were excluded from the surveillance program mainly because other co-morbidities and age. of the remaining 104 enrolled in surveillance, 90(87%) patients had their USS at 6 months interval, 2(2%) missed only one scan (not requested by clinician), 7(7%) failed to attend their appointments, 5(4%) either declined surveillance or were lost to follow up. aMAP score identified 70/104 (67%) high risk, 29 (28%) medium risk and only 5(5%) low risk for HCC. HCC was diagnosed in 4/104 patients after 3 years follow up (2 medium risk;2 high risk).Death was reported in 10/104 patients (1 HCC;4 liver failure;3 other cancers;1 post-operative complications following orthopaedic surgery;1 2ry to sepsis). Despite interruptions caused by COVID-19 pandemic, no HCC was diagnosed in 1st US scan after restarting the services. Conclusions HCC surveillance organised through a dedicated nurse-led stable cirrhosis clinic can achieve excellent adherence to planned USS intervals. Only a small number were identified as low risk within our cohort using the aMAP score offering limited opportunity to reduce the volume of USS for this indication in Derby.