P78 Navigating the way to excellent hepatocellular carcinoma surveillance – the benefits of a hepatology pathway navigator on surveillance invitation and uptake

<h3></h3> National Institute for Health and Care Excellence recommends adults with cirrhosis undergo surveillance every six months using abdominal ultrasound, with or without serum alpha-fetoprotein (AFP) measurement, for early detection of Hepatocellular Carcinoma (HCC) to enable timely treatment and improved survival outcomes. HCC surveillance varies across the UK. A national survey reported approximately 92% of healthcare centers have established surveillance programs, eligibility criteria and surveillance practice varies. 80% of the surveillance population have cirrhosis and high-risk patients with hepatitis B are also eligible. Surveillance compliance is generally high, though not consistently audited. Effective surveillance can result in a 30% relative and 10% absolute reduction in HCC mortality. However, elements such as underdiagnosis of early cirrhosis, screening practices and psychosocial factors impact surveillance program efficacy. Overall, heterogeneity in surveillance practice and uptake highlights the need to improve UK HCC surveillance programs to maximize early detection and treatment. <h3>Aim</h3> Quantitatively evaluate the impact of a Hepatology Pathway Navigator (HPN) on HCC surveillance invitation and uptake. The data of interest were ultrasound scans (USS) requested for HCC surveillance and AFP tests in two blocks of time: 01/01/2021 to 31/12/2022, pre HPN. This includes patients known to gastroenterology before 01/01/2021 requiring surveillance. 20/02/2024 to 20/08/2024, post HPN. This includes all surveillance program patients. <h3>Results</h3> Pre HPN: Over the two years all 198 patients identified should have received 4 AFP and 4 USS, 0% did. 114 (58%) received either an USS, AFP or both. 42% had no surveillance test. One (0.50%) had 4 USS and four (2.02%) had 4 AFP tests. 6 months pre HPN, 25 (12.63%) had USS, 60 (30.30%) had AFP tests and 20 (10.10%) received both USS and AFP tests. Post HPN: 310 patients were eligible for screening. 281 (90.6%) had USS only and 222 (71.6%) had both USS and AFP. This audit has quantitatively demonstrated the positive impact of a Hepatology Pathway Navigator on the HCC surveillance program. USS only screening has risen 77.97% and AFP and USS screening has risen 61.6%. Introducing an HPN has standardised screening invitation practice thus reducing health inequality. The long-term impact of a HPN on earlier HCC detection, treatment and survival is to be evaluated, but as earlier detection leads to a 30% relative and 10% actual reduction in mortality, we believe long-term outcomes will be significant. <h3>References</h3> NICE. Liver disease quality statement 4: Surveillance for hepatocellular carcinoma. <i>National Institute for Health and Care Excellence</i>. 17 June 2017. https://www.nice.org.uk/guidance/qs152/resources/liver-disease-pdf-75545536615621 Scott RA, Cross TJS, Clarke C, Khan SA, Ryder SD, Franklin J, Aravinthan AD. Outcome of national survey of the practice of hepatocellular carcinoma surveillance. <i>Journal of Hepatocellular Carcinoma</i>. 29 April 2023;<b>2013</b>(10):725–731. Kinsey E, Lee HM. Management of hepatocellular carcinoma in 2024: the multidisciplinary paradigm in an evolving treatment landscape.<i> Cancers</i>. 2024;<b>16</b>(3):666.