P97 Establishing and managing a nurse led hepatocellular Carcinoma (HCC) surveillance database to be compliant with NHS England guidance for early detection of HCC, promoting engagement with patients to aid compliance with cirrhosis follow up and opt

<h3></h3> Hepatocellular Carcinoma (HCC) is increasing in incidence in the UK. Cancer Research UK (2024) estimates that for men and women rates of HCC diagnosis has increased by 167% since 2016–2018. Even accounting for improved diagnostics and reporting of data this reflects a growing health problem facing the UK population. Funding from NHS England was granted for 12 months to establish a robust database and facilitate the smooth running of the HCC surveillance programme. This piece will document what was put in place and the insights gained over six months from November 2023 to May 2024. Establishing an accurate patient cohort was essential to ensure all eligible patients were offered face to face follow up, 6 monthly ultrasound scans and bloods. By collating the known cohort of patients and using patient records to capture cirrhosis patients seen in other work streams it was possible to categorise patients by the month their ultrasound was due. It was then a straightforward process to check which patients had undertaken their scans or not. Any abnormalities in the scan were identified and escalated in a timely manner. Patients that had not had a scan or missed clinic were followed up. Total number of patients 619. 16 HCCs were identified of which 50% were found in a surveillance pathway. Not all results were actioned – 2 patients later diagnosed with HCC had had imaging taken many months before which was not escalated resulting in delayed diagnosis. If a patient was being seen outside nurse led clinics, scans were not always seen or actioned in a timely manner. Patient’s miss clinics and ultrasounds for many reasons – but if contacted and re-instated 45% were seen or had their ultrasound. Contacting patients after missed appointments improves the compliance rate and reduces the number of patients discharged. It also allows for reasonable adjustments to be negotiated to help people engage with their health considering the possibility that not all patients are able to comply with the current model. However, this takes resources to implement. 50% of HCC’s were found in outside surveillance which gives a benchmark to aim for improvement. Burton et al (2024) found that the route to diagnosis for HCC’s was a predictor of outcomes, demonstrating that emergency presentations had a greater risk of reduced overall survival compared to patients that were diagnosed with HCC via the GP or as an outpatient. <h3>References</h3> Burton A, Wilburn J, Driver R, Wallace D, McPhail S, Cross TJS, Rowe IA, Marshall A. Routes to diagnosis of hepatocellular carcinoma patients: predictors and associations with treatment and mortality.<i> British Journal of Cancer</i>. 2024;<b>130</b>:1697–1708. Cancer Research UK. <i>Liver Cancer Incidence Statistics.</i> 2024. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer/incidenceheading-Two (Accessed 5th June 2024). NHS England. <i>NHS Long Term Plan ambitions for cancer.</i> 2019. Available at: https://www.england.nhs.uk/cancer/strategy/(Accessed 5^th June 2024). Scott R, Cross TJS, Clarke C, Khan SA, Ryder SD, Franklin J, Aravinthan AD. Outcomes of national survey of the practice of hepatocellular carcinoma surveillance. <i>Journal of Hepatocellular Carcinoma</i>. 2023;<b>10</b>:725–731. Tarao K, Nozaki A, Ikeda T, Sato A, Komatsu H, Komatsu T, Taguri M, Tanaka K. Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases – meta-analytic assessment. <i>Cancer Medicine</i>. 2019;<b>8</b>:1054–1065.