PDF | https://doi.org/10.46613/congastro2023-190
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Díaz L1, Fuentes E1, Norero B2, Corsi O1, Ayares G1, Idalsoaga F1, Pizarro G2, García S1, Vázquez V3, Lacalle L1, Arnold J1, Lazo M4, Ferreccio C1, Mendizabal M5, Piñero F5, Marín J6, Martinez E7, Roblero J8, Dirchwolf M9, Pollarsky F10, Guerra P11, Oliveira C12, Araujo R13, Reis M14, Toro L15, Restrepo J16, Maldonado K17, Sanchez A17, Ramírez W18, Infante M19, Carrera E20, Sanchez M21, Chavez N22, Mendez N22, Lombardo J23, Girala M24, Padilla M25, Díaz J26, Tagle M27, Menendez J28, Hernandez N28, Addissie B29, Ijeoma I30, Louvet A31, Piano S32, Cortez-Pinto H33, Wong V34, Kulkarni A35, Cotter T36, Brahmania M37, Dunn W38, Kamath P39, Singal A40, Debes J41, Reig M42, Loomba R43, Bataller R44, Lazarus J45, Arrese M1, Arab J46
1Pontificia Universidad Católica de Chile, Santiago, Chile
2Hospital Dr. Sótero del Río, Santiago, Chile
3Instituto Tecnológico De Monterrey, Monterrey, México
4Drexel University School of Public Health, Philadelphia, Estados Unidos (EEUU)
5Hospital Universitario Austral, Buenos Aires, Argentina
6Hospital Pablo Tobón Uribe, Medellin, Colombia
7Hospital Dr. Sótero del Rio, Santiago, Chile
8Hospital Clínico Universidad de Chile, Santiago, Chile
9Hospital Privado de Rosario, Rosario, Argentina
10Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
11Instituto Gastroenterológico Boliviano- Japonés, Cochabamba, Bolivia
12University of Sao Paulo School of Medicine, Sao Paulo, Brasil
13Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil
14University of São Paulo, Ribeirão Preto, Brasil
15Hospitales de San Vicente Fundación de Medellín y Rionegro, Medellin, Colombia
16Universidad de Antioquia, Medellin, Colombia
17Roosevelt Hospital, Ciudad de Guatemala, Guatemala
18Clínica Equilibrium, San José, Costa Rica
19Universidad de Ciencias Médicas de La Habana, Havana, Cuba
20Hospital Eugenio Espejo, Quito, Filipinas
21Hospital Escuela Universitario, Tegucigalpa, Honduras
22National Autonomous University of Mexico, Mexico City, México
23Hospital Punta Pacífica, Ciudad de Panamá, Panamá
24Universidad Nacional de Asunción, Asuncion, Paraguay
25Hospital Nacional Guillermo Almenara, Lima, Perú
26Hospital Nacional Edgardo Rebagliati Martins – Es up Salud, Lima, Perú
27Clinica Anglo Americana, Lima, Perú
28Unidad Bi Institucional Hospital Militar – Hospital de Clínicas, Montevideo, Uruguay
29Geisinger Medical Center, Danville, Estados Unidos (EEUU)
30University of Nigeria Nsukka Enugu Campus, Nsukka, Nigeria
31Hôpital Claude Huriez, Lille, Francia
32University of Padua, Padova, Italia
33Universidade de Lisboa, Lisboa, Portugal
34Chinese University of Hong Kong, Hong Kong, China (República Popular)
35Asian Institute of Gastroenterology, Hyderabad, India
36UT Southwestern Medical Center, Dallas, Estados Unidos (EEUU)
37Univeristy of Calgary, Calgary, Canadá
38University of Kansas Medical Center, Kansas, Estados Unidos (EEUU)
39Mayo Clinic, Rochester, Estados Unidos (EEUU)
40University of South Dakota Sanford School of Medicine, Sioux Falls, Estados Unidos (EEUU)
41University of Minnesota, Minneapolis, Estados Unidos (EEUU)
42Barcelona Clinic Liver Cancer group, Barcelona, España
43University of California at San Diego, San Diego, Estados Unidos (EEUU)
44Hospital Clinic, Barcelona, España
45CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, Estados Unidos (EEUU)
46Western University & London Health Sciences Centre, London, Canadá
Background: Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide.
Aims: To explore HCC-related population-wide public health policies (PHP) in terms of prevention, treatment availability, epidemiological surveillance, and awareness campaigns worldwide.
Methods: We conducted a 43-item survey about HCC: policies and civil society (18 questions), clinical guidelines (5 questions), epidemiology (7 questions), and care management (13 questions). The survey was carried out using an electronic form between May 2022 and January 2023. Data was revised by two independent reviewers and verified with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We classified policies into eight dimensions, including criteria for low, moderate, and strong PHP establishment. We estimated an index using multiple correspondence analysis.
Results: We obtained 134 responses from 66 countries/territories (Africa N=16, the Americas N=18, Asia N=10, Europe N=21, and Oceania N=1). The median index was 43.7 [IQR: 30.9–59.3]. The lower scores were observed in Sierra Leone (0), Lebanon (5.5), and Pakistan (5.5), while Italy (79.7), Brazil (94.1), and Sweden (100) obtained the highest scores (Figure). In particular, only 5 (7.6%) had a specific written national strategy or action plan on HCC. Thirty-two (48.5%) countries had national clinical practice guidelines on HCC and 54 (81.8%) had a national disease registry that included HCC. The most common strategies for staging HCC were Barcelona Clinic Liver Cancer (BCLC) (85%) and TNM classification (10%). The survey reflects important differences in the availability of treatments, including surgery (98.4%), tyrosine kinase inhibitors (95.1%), chemoembolization (85.2%), radiofrequency or alcohol ablation (82%), immunotherapy plus anti-VEGF (82%), liver transplant (74.2%), stereotactic body radiation therapy (42.6%), and radioembolization (36.4%).
Conclusions: Existence of PHP on HCC is insufficient worldwide. The most common strategy for staging is BCLC, but there are important differences in treatment availability across countries, especially regarding curative therapies.
