Quality standard

Quality statement 4: Surveillance for hepatocellular carcinoma

Quality statement 4: Surveillance for hepatocellular carcinoma

Quality statement

Adults with cirrhosis are offered 6-monthly surveillance for hepatocellular carcinoma.

Rationale

Cirrhosis is a substantial risk factor for hepatocellular carcinoma. Hepatocellular carcinoma develops quickly and may be asymptomatic until it is advanced. Regular surveillance of adults with cirrhosis at 6‑month intervals helps to ensure that it is detected early. Treatment can then begin promptly, which can improve the person's chances of survival.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with cirrhosis are offered 6‑monthly surveillance for hepatocellular carcinoma.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols.

Process

Proportion of adults with cirrhosis who received ultrasound surveillance for hepatocellular carcinoma within the past 6 months.

Numerator – the number in the denominator who received ultrasound surveillance for hepatocellular carcinoma within the past 6 months.

Denominator – the number of adults with cirrhosis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from audit of patient health records.

Outcome

a) Proportion of adults with cirrhosis who are diagnosed with hepatocellular carcinoma at an early stage.

Numerator – the number in the denominator who are diagnosed with hepatocellular carcinoma at an early stage.

Denominator – the number of adults with cirrhosis who are diagnosed with hepatocellular carcinoma.

Data source: National Cancer Registration and Analysis Service cancer outcomes and services dataset. Early-stage diagnosis may be based, for example, on stages 0 or A of the Barcelona Clinic Liver Staging classification.

b) Hepatocellular carcinoma survival rates.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from audit of patient health records. Hepatocellular carcinoma is included within liver cancer in the Office for National Statistics' cancer survival for adults in England.

What the quality statement means for different audiences

Service providers (such as hospitals, and specialist liver centres) have recall systems in place to ensure that adults with cirrhosis are offered 6‑monthly surveillance for hepatocellular carcinoma.

Healthcare professionals (such as gastroenterologists and hepatologists) ensure that adults with cirrhosis are routinely offered 6‑monthly surveillance for hepatocellular carcinoma.

Commissioners commission services that have recall systems in place to offer 6‑monthly surveillance for hepatocellular carcinoma to adults with cirrhosis.

Adults with cirrhosis should have a check for liver cancer every 6 months. This will ensure that they can be offered treatment as early as possible if liver cancer develops.

Source guidance

Definitions of terms used in this quality statement

Adults with cirrhosis

Adults aged over 18 diagnosed with cirrhosis, excluding people who are receiving end of life care. [NICE's guideline on cirrhosis in over 16s, recommendations 1.2.4 and 1.2.6]

6-monthly surveillance for hepatocellular carcinoma

Ultrasound surveillance with or without measurement of serum alpha-fetoprotein. Surveillance for adults with cirrhosis who have hepatitis B should include alpha‑fetoprotein testing. [NICE's guideline on cirrhosis in over 16s, recommendation 1.2.4, and NICE's guideline on hepatitis B (chronic), recommendation 1.7.1]

Equality and diversity considerations

Adults with cirrhosis who are experiencing homelessness or who inject drugs may need additional support from community outreach services to ensure that they attend for 6‑monthly surveillance for hepatocellular carcinoma. This support may be available from the homelessness multidisciplinary team (for more information, see NICE's guideline on integrated health and social care for people experiencing homelessness, recommendations 1.3.2 and 1.5.15).

Prisons should ensure that prisoners with cirrhosis are offered 6‑monthly surveillance for hepatocellular carcinoma.