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Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

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Gerda Elisabeth Villadsen, Kira Simonsen, Peter Ott, Hendrik Vilstrup, Henning Grønbæk

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.281.dnk

Background & Aims: In 2009, the Danish Government instituted “Fast Track Clinical Pathways” (FTCP) to accelerate diagnosis and treatment of cancers including hepatocellular carcinoma (HCC). We examined how the implementation of FTCP affected the time from referral to diagnosis and treatment as well as the patient survival.
Methods: 309 consecutive patients with suspected HCC were included, 79 referred during the period 2007- 2008 (before FTCP) and 230 during 2009-2011. Of those, 271 (88%) were diagnosed with HCC and 161 (60%) had cirrhosis, in most cases caused by alcohol.
Results: The time from referral to the first visit was reduced from a mean 16.4 (11.5) to 5.4 (6) days (p<0.001) and the time from the first visit to the Multidisciplinary Tumour Conference (MDT) treatment decision from 34.9 (27.9) to 16.1 (14.4) days (p<0.001). The total time from referral to treatment was reduced from 53.2 (37.9) to 35.9 (23.1) days (p<0.001). There was a weak trend of improved survival after FTCP: 231 (147-368)
vs. 293 (227-396) days (p=0.11).
Conclusions: The implementation of FTCP reduced the total time from referral to treatment by three weeks; however, without significant effects on overall mortality. While shortened waiting time is a comfort for the patient, it remains to be elucidated whether it will change the prognosis.
Key words: hepatocellular carcinoma − fast track clinical pathway − survival.
Abbreviations: FTCP: Fast Track Clinical Pathway; HCC: hepatocellular carcinoma; MDT: multidisciplinary tumour conference; RFA: radiofrequency ablation; CT: computed tomography; MRI: magnetic resonance imaging; MELD: Model for End-Stage Liver Disease; WHO: World Health Organisation; SD: Standard deviation.