National survey of real-world treatment patterns for early- and intermediate-stage hepatocellular carcinoma reveals wide variation across Australian states.

backgroundHepatocellular carcinoma (HCC) is a heterogeneous and multi-disease state that is complex to manage and requires a multidisciplinary approach to optimise patient care. Best practice recommendations were proposed in the Australian HCC consensus statement published in 2020.

aimThis study aimed to compare the patterns of care between Australian states for patients with very-early- to intermediate-stage HCC.

methodsMultidisciplinary specialists involved in HCC management (n = 86) participated in one of six state-based meetings across Australia. Specialists were surveyed on their preferred management approaches at key clinical decision points for four patient case studies of very early- to intermediate-stage HCC.

resultsAcross Australia, approaches to HCC surveillance and diagnosis were concordant between states and aligned with the Australian HCC consensus statement recommendations. However, there was wide deviation between states in HCC treatment and monitoring strategies, particularly in the choice of imaging modality for assessing response to therapy, choice of locoregional therapy and consideration and timing of systemic therapy. The main factors contributing to variance between states in patterns of care for patients with very-early- to intermediate-stage HCC included accessibility of technology, centre expertise, collaborations and access to and participation in clinical trials.

conclusionsIn Australia, there is wide variation between states in the patterns of care for patients with very-early- to intermediate-stage HCC. The variation in HCC patterns of care between states likely reflects the rapidly evolving HCC treatment landscape and differential access to new therapeutic modalities and local expertise.