Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Management of hepatocellular carcinoma (HCC) often involves many subspecialist providers, as well as a broad range of treatment options. This study sought to evaluate referral and treatment patterns among patients with HCC at a large academic medical center. Data from our cancer registry between 2003-2011 were abstracted on 394 patients who were primarily diagnosed/treated for HCC at Johns Hopkins Hospital (JHH); data on patients who were diagnosed/treated with HCC elsewhere and who received secondary treatment at JHH (n = 391) were also abstracted for comparison purposes. Among the main cohort, the most common specialties to be consulted were surgery (n = 225, 57.1 %), gastroenterology (n = 225, 57.1 %), and interventional radiologist (n = 206, 52.3 %), while only 96 (24.4 %) were referred to medical oncology. Factors associated with surgical consultation included younger age (odds ratio (OR) 3.35, 95 % CI 1.62-6.92), tumor size < 5 cm (OR 1.82, 1.09-3.02), and unilobar disease (OR 2.94, 1.31-6.59) (all P < 0.05). Patients initially diagnosed/treated elsewhere had larger tumors (4 vs. 6 cm), bilateral disease (19.2 vs. 26.8 %), and were more likely to be seen by interventional radiology (all P < 0.05) Most patients were seen by surgeons, gastroenterologists, or interventional radiologists, with only a minority being seen by medical oncologists. Referral patterns depended on patient-level factors, as well as extent of disease.