A. Mokdad1, A. Singal1, J. Mansour1, G. Balch1, M. Choti1, A. Yopp1 1University Of Texas Southwestern Medical Center,Surgery Oncology,Dallas, TX, USA
Introduction: Hepatocellular carcinoma (HCC) treatment involves multiple specialties risking delayed treatment and worse outcomes. The aim was evaluating outcomes following implementation of a voice messaging system (VMS) designed to reduce delays in treatment following HCC diagnosis.
Methods: A retrospective study of HCC patients was conducted in an outpatient safety net hospital between February 2008 and January 2012. In February 2010, VMS notification of HCC to the ordering physician and downstream treating physicians was implemented. Patients were divided into: 1) pre-intervention: diagnosis two years prior to implementation or failure of notification following implementation, 2) post-intervention: diagnosis two years following implementation. Demographics, tumor characteristics, treatment, and survival were compared.
Results: Ninety-seven patients diagnosed with HCC, 51 in the pre-intervention group and 46 in the post-intervention group. The main etiology of chronic liver disease was HCV infection and no differences in symptoms, liver dysfunction, tumor characteristics, or treatment were observed between groups. The time from diagnosis to clinic contact (0.5 months vs. 2.9 months, p=0.003) and time from detection to treatment (2.2 months vs. 5.5 months, p=0.005) was significantly shorter following VMS. BCLC A status (HR 3.4, 95%CI 2,6), treatment (HR 2.0, 95%CI 1,4), and VMS (HR 1.7, 95%CI 1,3) were independently associated with improved overall survival. Patients diagnosed following VMS had a median survival of 31.7 months compared to 15.7 months, p=0.008.
Conclusion: Implementation of VMS reduces time to treatment and reduction in time to initial clinic visit. Reduction in time to treatment is associated with improved outcome independent of tumor stage, underlying liver function, and treatment.