Controlling liver cancer internationally: A qualitative study of clinicians' perceptions of current public policy needs
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RESEARCH
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Controlling liver cancer internationally: A qualitative study of clinicians’ perceptions of current public policy needs John FP Bridges1, Gisselle Gallego1* and Barri M Blauvelt2
Abstract Background: Liver cancer is the fifth most common cancer in men and the seventh for women. Usually because of late diagnosis, the prognosis for liver cancer remains poor, resulting in liver cancer being the third most common cause of death from cancer. While some countries have treatment guidelines, little is known or understood about the strategies needed for liver cancer control internationally. Objective: To explore leading liver cancer clinician’s perceptions of the current public policy needs to control liver cancer internationally. Methods: Key informant interviews were conducted with a range of liver cancer clinicians involved in policy in eleven countries. Interviews were digitally recorded, transcribed verbatim, translated (where necessary), deidentified and analyzed by two researchers using a constant comparative method. Results: Twenty in-depth semi-structured interviews were conducted in: Australia, China, France, Germany, Italy, Japan, Spain, South Korea, Taiwan, Turkey and the United States. Nine themes were identified and cluster into three groups: 1) Promoting prevention via early risk assessment, focusing on viral hepatitis and other lifestyle factors; 2) Increasing political, public and medical community awareness; and 3) Improving funding for screening, liver cancer surveillance and treatment. Conclusion: This study is an important step towards developing an evidence-based approach to assessing preparedness for implementing comprehensive liver cancer control strategies. Evaluation mechanisms to assess countries’ performance on the needs described are needed. Future research will concentrate of understanding how these needs vary across countries and the optimal strategies to improve the diagnosis and prognosis of patients with liver cancer internationally.
Introduction Liver cancer is the fifth most common cancer in men and the seventh in women, because of its high fatality it is the third most common cause of death from cancer worldwide [1]. Hepatocellular carcinoma (HCC) is the predominant histologic subtype compromising approximately 85-90% of all primary liver cancers [2]. In 2008 there were an estimated 695 000 deaths from HCC globally among whom at least two thirds of these were in the Asia Pacific region [3]. Most HCCs are discovered * Correspondence: [email protected] 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Full list of author information is available at the end of the article
late in advance stages due to the relative dearth of symptoms in early stages and the rapid doubling of the tumor [4]. Median survival of patients is estimated at less than a year and less than five months without effective treatment [5]. Clinical guidelines have been developed by the American Association for the Study of Liver
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