Inequalities in hepatocellular carcinoma (HCC) surveillance uptake in London: a UK multicentre cohort study.

Introduction: Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related mortality worldwide. 6 monthly ultrasound surveillance for HCC is recommended by professional bodies, but fewer than 25% of patients receive surveillance at recommended intervals. The aim of this study was to describe surveillance uptake across a multicentre cohort, examining sociodemographic factors and predictors of surveillance attendance. Methods: Electronic healthcare data from North West London primary care were used to identify numbers of patients with chronic liver disease between March 2021 and March 2023. A case review of patients eligible for HCC surveillance was then conducted using hospital care records. Data were collected including surveillance attendance and sociodemographic factors. Surveillance attendance was classified: regular (four surveillance episodes in 2 years), infrequent (less than four attendances) or non-attendance. Regression analysis was undertaken to examine factors associated with regular or reduced attendance. Results: 2195 patients were identified as having cirrhosis from primary care; 869 patients were identified from hospital care records as being under the care of hepatology/gastroenterology clinics and eligible for surveillance. Of these, 17% patients received regular surveillance; 73% of patients were in receipt of infrequent surveillance and 10% received no surveillance over the study period. The strongest predictor of regular surveillance was care under a specialist hospital (OR 0.08, 95% CI 0.04 to 0.2, p<0.001). People who were not deprived were more likely to be regular attenders (OR 0.4, 95% CI 0.2 to 0.8, p=0.008). Conclusions: Rates of regular HCC surveillance are low, with patients under the care of non-specialist centres most at risk of reduced attendance at surveillance. Our findings highlight the urgent need to address low surveillance uptake.