Advancing multidisciplinary management of HCC with cirrhosis in community-based settings.

Abstract

532 Background: Liver cancer mortality remains high in the US, with a 5-year survival rate of 22%. Most patients with hepatocellular carcinoma (HCC) also have cirrhosis, which complicates management and worsens outcomes. This multi-center quality improvement initiative was designed to strengthen multidisciplinary HCC management in community settings. Methods: Between 10/2024 and 12/2024, oncology team members from 6 US community oncology practices and regional gastroenterologists/hepatologists (N = 49) completed surveys assessing attitudes, knowledge, practice patterns, and challenges in managing HCC with cirrhosis. Teams then participated in audit-feedback sessions to review baseline data and develop action plans to address gaps in multidisciplinary care. Results: Only 34% of providers reported familiarity (4/5 on 5-point Likert scale) with current guidelines for the management and treatment of HCC in patients with cirrhosis. Despite guideline recommendations, only 21% of providers reported always obtaining upper endoscopy before starting atezolizumab plus bevacizumab, and 31% did not take any specific steps to ensure upper endoscopy scheduling/completion. Only 13% reported making treatment decisions with a multidisciplinary team for every HCC patient with cirrhosis, 46% for most patients, and 29% for some patients. Top barriers to guideline-concordant management for HCC and cirrhosis were keeping up with the latest guidelines (49%), limited access to specialists or scheduling days for upper endoscopy (49%), and individualizing treatment plans based on patient-, disease-, and treatment-related factors (39%). While 36% of providers reported presenting most of their HCC patients with cirrhosis at a multidisciplinary tumor board (MTB), 27% reported presenting only complex cases . Oncologists (71%) and radiologists (69%) were reported as most frequently included in MTBs, while less than half reported interventional radiologists (43%) and transplant and hepatobiliary surgeons (39%). Providers believed more comprehensive management and treatment guidelines (51%), more education on the management and treatment guidelines (51%), and enhanced collaboration with other specialists (49%) would be most helpful to improve outcomes for patients with HCC and cirrhosis. Action plans developed across sites focused on strengthening multidisciplinary collaboration, improving access and timeliness of endoscopy, supporting individualized treatment planning, and leveraging navigators to coordinate care. Conclusions: Despite current guidelines, gaps persist in the management of HCC patients with cirrhosis, including inconsistent guideline-concordant care and suboptimal multidisciplinary collaboration. These findings highlight both the persistent challenges and the actionable opportunities to improve evidence-based multidisciplinary care in community-based settings.