Observational Study
Copyright
©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2015; 7(9): 161-171
Published online Sep 15, 2015. doi: 10.4251/wjgo.v7.i9.161
Table 1 Personal data of participating physicians
n (154)% Age (yr) 24-35 69 45 36-45 43 28 46-65 42 27 Sex Male 104 67.5 Female 50 32.5 Specialty GP 3 2 Tropical Medicine 78 50 Internal Medicine 48 31 Gastroenterology 4 3 Others 21 14 Highest qualification MBBCH 25 16 Msc 49 32 MD 69 45 Others 11 7 Clinical practice Primary Health Care 4 3 MOH 51 33 University Hospital 95 61 Private practice 4 3
Table 2 Relation of the physicians’ age and knowledge of hepatocellular carcinoma epidemiology
Age (yr) P value< 45 ≥45 n % n % Recommended HCC surveillance Chronic hepatitis B, C and liver cirrhosis 94 84 39 93 0.15 Positive family history 36 32 18 43 0.215 Everyone 19 17 3 7 0.121 Reduction of deaths from HCC by screening 0.419 < 30% 25 22 12 29 ≥ 30% 87 787 30 71 Risk factors for liver disease progression Age 49 448 14 33 0.242 Regular alcohol consumption 49 44 22 52 0.339 Gender 33 29 17 40 0.194 Obesity, DM 42 37 13 31 0.45 HCV genotype 54 48 32 76 0.002a HBV-HCV co-infection 60 54 18 43 0.236 Leading cause of HCC in Egypt 0.11 HCV 93 83 30 71 HBV 19 17 12 29 Causes of death of HCC patients 0.096 Cancer 49 44 18 43 Liver failure 34 302 19 45 GI or variceal bleeding 29 25 5 12
Table 3 Relation between physicians’ specialty and knowledge of hepatocellular carcinoma epidemiology
Specialty P valueSpecialty A1 Specialty B2 n % n % People who should undergo HCC surveillance Chronic hepatitis B, C and liver cirrhosis 117 90 16 67 0.006a Positive family history 51 39 3 12 0.112 Everyone 15 11 7 29 0.023a Reduction of deaths from HCC by screening 0.903 < 30% 31 24 6 25 ≥ 30% 99 76 18 75 Risk factors for disease progression Age 54 41 9 0.712 Regular alcohol consumption 63 48 8 33 0.172 Gender 47 36 3 12 0.023a Obesity, DM 50 38 5 21 0.098 HCV genotype 74 57 12 50 0.53 Co-infection 69 53 9 37 0.161 Most common cause of HCC 0.711 HCV 105 81 18 75 HBV 25 19 6 25 Cause of death of HCC patients 0.217 Cancer 59 45 8 33 Liver failure 41 32 12 50 GI or variceal bleeding 30 23 4 17
Table 4 Relation between physicians’ qualification and knowledge of hepatocellular carcinoma epidemiology
Highest qualification P valueMBBCH Msc/diploma MD n % n % n % People who should undergo HCC surveillance Chronic hepatitis B, C and liver cirrhosis 23 92 51 85 59 85 0.666 Positive family history 8 32 10 17 36 52 0.000a Everyone 4 16 8 13 10 14 0.948 Reduction of deaths from HCC by screening 0.581 < 30% 8 32 14 23 15 22 ≥ 30% 17 68 46 77 54 78 Risk factors for progression of the disease Age 11 44 21 35 31 45 0.49 Regular alcohol consumption 10 40 26 43 35 51 0.562 Gender 4 16 13 22 33 48 0.001a Obesity, DM 8 32 19 32 28 41 0.525 HCV genotype 10 40 29 48 47 68 0.017a Co-infection 9 36 28 47 41 59 0.098 Leading cause of HCC 0.053 HCV 19 76 43 72 61 88 HBV 6 24 17 28 8 12 Cause of death of HCC patients 0.427 Cancer 12 48 25 42 30 43 Liver failure 7 28 18 30 28 41 GI or variceal bleeding 6 24 17 28 11 16
Table 5 Relation between hospital setting and knowledge of hepatocellular carcinoma epidemiology
Type of hospital P valueUniversity MOH n % n % People who should undergo HCC surveillance Chronic hepatitis B, C and liver cirrhosis 79 83 54 91 0.141 Positive family history 44 46 10 17 0.000a Everyone 17 18 5 8 0.104 Reduction of deaths from HCC by screening 0.749 < 30% 22 23 15 25 ≥ 30% 73 77 44 75 Risk factors for progression of the disease Age 43 45 20 34 0.163 Regular alcohol consumption 47 49 24 41 0.287 Gender 37 39 13 22 0.029a Obesity, DM 37 39 18 30 0.288 HCV genotype 55 58 31 52 0.516 HBV-HCV co-infection 50 53 28 47 0.532 Leading cause of HCC 0.011a HCV 82 86 41 70 HBV 13 14 18 30 Cause of death of HCC patients 0.493 Cancer 43 45 24 41 Liver failure 34 36 19 32 GI or variceal bleeding 18 19 16 27
Table 6 Relation between doctors’ age and knowledge about screening modalities, educational resources and guidelines
Age (yr) P value< 45 ≥45 n % n % Most important HCC screening 0.037a Physical examination 2 2 1 3 Alpha fetoprotein 27 24 9 21 Ultrasound 65 58 32 76 CT 18 16 0 0 2nd most important HCC screening 0.175 Physical examination 2 2 0 0 Alpha fetoprotein 55 49 16 38 Ultrasound 17 15 4 10 CT 36 32 22 52 Angiography 2 2 0 0 3rd most important HCC screening 0.585 Physical examination 3 3 2 5 Alpha fetoprotein 21 19 13 31 Ultrasound 14 12 3 7 CT 55 49 18 43 Angiography 8 7 3 7 Laparoscopy 11 10 3 7 Screening interval for high risk groups 0.212 3 mo 65 58 29 69 6 mo or more 47 42 13 31 HBV treatment reduces HCC incidence 0.014a Yes 84 75 39 93 No 28 25 3 7 Familiar with guidelines 0.205 Yes 62 55 28 67 No 50 45 14 33 HCV RNA/ALT level are HCC risk factors 0.08 Yes 57 51 28 67 No 55 49 14 33
Table 7 Relation between medical specialty and knowledge about screening modalities, educational resources and guideline
Specialty A Specialty B P valuen % n % Most important screening for HCC 0.154 Physical examination 2 2 1 4 Alpha fetoprotein 28 21 8 33 Ultrasound 82 63 15 63 CT 18 14 0 0 2nd most important screening for HCC 0.238 Physical examination 2 2 0 0 Alpha fetoprotein 64 49 7 29 Ultrasound 16 12 5 21 CT 47 36 11 46 Angiography 1 1 1 4 3rd most important screening for HCC 0.383 Physical examination 3 2 2 9 Alpha fetoprotein 27 21 7 29 Ultrasound 16 12 1 4 CT 61 47 12 50 Angiography 10 8 1 4 Laparoscopy 13 10 1 4 Screening interval for high risk group 0.010a Every 3 mo 85 65 9 38 6 mo or more 45 35 15 62 HBV treatment reduces HCC incidence 0.139 Yes 107 82 16 67 No 23 18 8 33 Guidelines in management of HCC 0.991 Yes 76 58 14 58 No 54 42 10 42 HCV RNA/ALT risk factors for HCC 0.147 Yes 75 58 10 42 No 55 42 14 58
Table 8 Relation between highest qualification and knowledge about screening modalities, educational resources and guidelines
Highest qualification P valueMBBCH Msc/diploma MD n % n % n % Most important screening for HCC 0.023a Physical examination 0 0 1 2 2 3 Alpha fetoprotein 7 28 13 22 16 23 Ultrasound 14 56 33 55 50 73 CT 4 16 13 22 1 1 2nd most important examination in screening of HCC 0.585 Physical examination 1 4 1 2 0 0 Alpha fetoprotein 12 48 26 43 33 48 Ultrasound 2 8 11 18 8 12 CT 9 36 22 37 27 39 Angiography 1 4 0 0 1 1 3rd most important screening for HCC 0.004a Physical examination 1 4 3 5 1 1 Alpha fetoprotein 3 12 14 23 17 25 Ultrasound 6 24 2 3 9 13 CT 12 48 25 42 36 52 Angiography 1 4 4 7 6 9 Laparoscopy 2 8 12 20 0 0 Screening interval for high risk group 0.050a Every 3 mo 15 60 30 50 49 71 6 mo or more 10 40 30 50 20 29 HBV treatment reduces HCC incidence 0.441 Yes 20 80 45 75 58 84 No 5 20 15 25 11 16 Guidelines in management of HCC 0.000a Yes 13 52 20 33 57 83 No 12 48 40 67 12 17 HCV RNA/ALT risk factors for HCC 0.368 Yes 14 56 37 62 34 49 No 11 44 23 38 35 51
Table 9 Relation between health care setting and knowledge about screening modalities, educational resources and guidelines
Health care setting P valueUniversity MOH n % n % Most important screening for HCC 0.000a 0.000a 3 3 0 0 Alpha fetoprotein 19 20 17 29 Ultrasound 70 74 27 46 CT 3 3 15 25 2nd most important screening for HCC 0.799 Physical examination 1 1 1 2 Alpha fetoprotein 47 49 24 40 Ultrasound 11 12 10 17 CT 35 37 23 39 Angiography 1 1 1 2 3rd most important screening for HCC 0.001a Physical examination 2 2 3 5 Alpha fetoprotein 23 24 11 19 Ultrasound 10 11 7 12 CT 52 55 21 36 Angiography 7 8 4 7 Laparoscopy 1 1 13 22 Screening interval for high risk group 0.173 Every 3 mo 62 65 32 54 6 mo or more 33 35 27 46 HBV treatment reduces HCC incidence 0.011a Yes 82 86 41 69 No 13 14 18 31 Guidelines in management of HCC 0.000a Yes 73 77 17 29 No 22 23 42 71 HCV RNA/ALT are risk factors for HCC 0.139 Yes 48 51 37 63 No 47 49 22 37
Table 10 Relation between physicians’ age and hepatocellular carcinoma screening
Age (yr) P value< 45 ≥ 45 n % n % HCC surveillance 0.013 Yes 20 18 15 35 No 92 82 27 65 Screening of patients with HCV cirrhosis and SVR 0.661 Yes 94 4 34 81 No 18 16 8 19 Screening of patients with hemochromatosis 0.11 Yes 73 65 33 79 No 39 35 9 21 No. of incidental HCCs/month 0.087 0 34 30 7 17 1 or more 78 0 35 83 No. of HCCs/month 0.193 0 33 29 8 19 1 or more 79 71 0.000a 81
Table 11 Hepatocellular carcinoma screening depending on medical specialty
Specialty P valueSpecialty A1 Specialty B2 n % n % HCC surveillance 0.193 Yes 32 25 3 13 No 98 75 21 87 Screening of patients with HCV cirrhosis and SVR 0.79 Yes 109 84 19 79 No 21 16 5 21 Screening of patients with hemochromatosis 0.030a Yes 94 72.3 12 50 No 36 27.7 12 50 No. of incidental HCCs/month 0.418 0 33 25 8 33 1 or more 97 75 16 67 No. of HCCs/month 0.759 0 34 26 7 29 1 or more 96 74 17 71
Table 12 Hepatocellular carcinoma screening depending on highest medical qualification
Highest qualification P valueMBBCH Msc/ diploma MD n % n % n % HCC surveillance 0.0423 Yes 5 20 10 17 17 25 No 20 80 50 83 52 75 Screening of patients with HCV cirrhosis and SVR 0.638 Yes 20 80 52 87 56 81 No 5 20 8 13 13 19 Screening of patients with hemochromatosis 0.012a Yes 15 60 35 58 56 81 No 10 40 25 42 13 19 No. of incidental HCCs/month 0.000a 0 11 44 24 40 6 9 1 or more 14 56 36 60 63 91 No. of HCC patients 0.000a 0 9 36 29 48 3 4 1 or more 16 64 31 52 66 96
Table 13 Hepatocellular carcinoma C screening depending on health care setting
Health care setting P valueUniversity hospital MOH n % n % HCC surveillance 0.178 Yes 25 26 10 17 No 70 74 49 83 Screening of patients with HCV cirrhosis and SVR 0.386 Yes 77 81 51 86 No 18 19 8 14 Screening of patients with hemochromatosis 0.196 Yes 69 73 37 63 No 26 27 22 37 No. of incidental HCCs/month 0.000a 0 10 10 31 53 1 or more 85 90 28 47 No. of HCCs/month 0.000a 0 9 10 32 54 1 or more 86 90 27 46