Retrospective cohort study of pandemic-related disruptions in hepatocellular carcinoma surveillance in safety-net settings

Pandemic-related disruptions in cirrhosis care resulted in major gaps and delays in surveillance for hepatocellular carcinoma (HCC). It is not clear whether these initial declines improved and rebounded to prepandemic levels. A retrospective cohort study at 5 safety-net health systems in the US evaluated clinical practice data on HCC surveillance utilization from before the COVID-19 pandemic to 4 years after the onset of the pandemic among safety-net populations with cirrhosis. Adult patients with cirrhosis (n=6940; 57.7% men; median age 58 years; IQR 52-64) were evaluated across 3 time periods: March 1,2018 to February 29, 2020 (pre-COVID-19 period), March 1, 202 to February 28, 2022 (COVID-19 era), and March 1, 2022 to February 29, 2024 (post-COVID-19 period). The proportion of patients who underwent HCC surveillance within 6 months after diagnosis was 30.8% in the pre-COVID-19 period, which declined to 21.1% in the COVID-19 era, and remained at 22.3% in the post-COVID-19 period. Consistent trendse were observed among men and women and among all age and race groups, except for Asian individuals, for whom there was an observed increase in the post-COVID-19 period. Similar trends of low HCC surveillance post-COVID-19 were observed across insurance types but was particularly concerning among uninsured or indigent care covered patients (only 11.9% in the most recent period). The authors conclude that rates of HCC surveillance following pandemic-related declines remained persistently low even up to 4 years after the onset of the pandemic, with fewer than 1 in 4 patients undergoing guideline-concordant HCC surveillance.