HCC Surveillance: Common Goals, Collective Impact

Topics: Featured
May 30, 2022

As the COVID-19 pandemic has brought to light and amplified a range of longstanding issues within our healthcare system, the task before us is clear but no less daunting: Do more to enable value-based care and achieve the goals of Triple, Quadruple, and emerging Quintuple Aim.


From Triple to Quintuple Aim: an evolution

In 2007, the Institute of Healthcare Improvement introduced the Triple Aim as the key to healthcare transformation. Its three goals include: (1) Improving the patient experience of care, (2) Improving the health of populations, and (3) Reducing the per capita cost of healthcare.1

A few years later, in response to higher rates of physician burnout, the Triple Aim evolved into the Quadruple Aim to also include: (4) Improving the clinician experience. Today, the concept is evolving yet again to become the Quintuple Aim, incorporating (5) health equity as another key element necessary to truly achieve improved patient care, outcomes, and costs.2


Striving to raise the standard of HCC surveillance

Liver cancer is one of the leading causes of cancer-related deaths worldwide.3 Up to 85% of all liver cancers are attributed to hepatocellular carcinoma (HCC), which has a five-year survival rate of approximately 20%.3,4 Unfortunately, the sensitivity of recommended HCC surveillance methods—ultrasound with or without alpha-fetoprotein (AFP) testing—is suboptimal, and patient adherence to routine surveillance testing is poor.4,5

As a result, it can be challenging for healthcare providers to align HCC surveillance with Triple, Quadruple, and/or Quintuple Aim goals. But a new approach can help. The Oncoguard® Liver solution combines a clinical blood test for the detection of markers associated with HCC at any stage with a turnkey patient engagement program. Its design reflects active collaboration with a growing community of clinical thought leaders committed to improving HCC surveillance.


How the Oncoguard® Liver solution can help clinicians align with Quintuple Aim goals

The Oncoguard® Liver solution can be used as a valuable tool to help clinicians align their HCC surveillance with the goals laid out by the Institute of Healthcare Improvement. Here’s how.


Improving the health of populations. The Oncoguard® Liver solution features a breakthrough, multi-target blood test that delivers high sensitivity for the detection of HCC, especially in early-stage disease. The test was developed and validated through one of the largest HCC case-controlled sample collection studies—using samples from more than 70 sites in the US, European Union, and Asia—and is undergoing continual validation with clinical and real-world evidence.6 The strong performance of the Oncoguard™ Liver test may enable early-stage HCC detection and an opportunity for curative treatments, essential for improving patient outcomes.7


Improving the patient experience of care. The Oncoguard® Liver solution was designed with the patient experience in mind. While it’s estimated that three million patients in the US qualify for HCC surveillance, overall surveillance utilization is estimated to be less than 30%.8,9 Patients report that one of the barriers to receiving HCC surveillance is difficulty with the scheduling process,10 which requires coordinating an ultrasound in one place and an AFP test possibly elsewhere. Another barrier may be frequency, as guidelines recommend surveillance every six months for at-risk patients. If the patient experience is repeatedly poor, patients may be less likely to adhere to ongoing testing. The Oncoguard® Liver test is one simple blood test—versus the two-step process—potentially making it more convenient for patients. The solution also includes a flexible and customizable Patient Engagement Program that provides educational materials to keep patients informed, along with ongoing reminders to help them stay up to date with regular testing.


Improving the clinician experience. The Oncoguard® Liver solution is practical, meaning it can easily be integrated into clinicians’ workflows. The multi-target blood test provides objective assessment, with results generated in a format that’s easy to read and interpret. And the comprehensive Patient Engagement Program can support clinicians in driving patient adherence. In fact, the program design draws from proven tactics shown to increase surveillance adherence by as much as 60%–80%.9


Be part of the collective journey

We believe that the relentless pursuit for earlier HCC detection requires a collective journey. In order to better align surveillance methods with value-based care and the goals of Quintuple Aim, all of us must work together to make it easier for patients to adhere to testing while improving the quality of care they receive. With the Oncoguard® Liver solution, we can help make early-stage HCC detection a reality for more patients. Join us.

Looking Ahead

As together we pursue solutions to enable early-stage HCC detection, how will we measure progress? And what more can be done to motivate patients to better adhere? Stay tuned for future blog posts that will address these questions and others.

Visit us again soon at OncoguardLiver.com/education to learn more about the future of HCC surveillance. We’ve assembled webinars, videos, scientific publications, and professionally oriented blogs to provide access to a wide variety of up-to-date educational resources. 


The foregoing information is for informational purposes only and is not treatment advice for any patient. Physicians should use their clinical judgment and experience when deciding how to diagnose or treat patients.


Institute for Healthcare Improvement. The IHI Triple Aim. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

Itchhaporia D. The evolution of the Quintuple Aim: health equity, health outcomes, and the economy. JACC. 2021;78(22):2262-2264.

Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021. doi:10.3322/caac.21660

American Cancer Society. Cancer facts & figures. 2021. Accessed March 3, 2022. Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html

Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723-750. doi:10.1002/hep.29913

Exact Sciences Corporation. Blood sample collection to evaluate biomarkers for hepatocellular carcinoma. NLM identifier: NCT03628651. Accessed March 3, 2022. Available at: http://www.clinicaltrials.gov/ct2/show/NCT03628651

Chalasani NP, Porter K, Bhattacharya A, Book AJ, Neis BM, Xiong KM, Ramasubramanian TS, Edwards V DK, Chen I, Johnson S, Roberts LR, Kisiel JB, Reddy KR, Singal AG, Olson MC, Bruinsma JJ, Validation of a novel multi-target blood test shows high sensitivity to detect early-stage hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2021. doi: https:// doi.org/10.1016/j.cgh.2021.08.010 

Beste LA, Ioannou GN, Yang Y, et al. Improved surveillance for hepatocellular carcinoma with a primary care-oriented clinical reminder. Clin Gastroenterol Hepatol. 2015;13(1):172-179. doi:10.1016/j.cgh.2014.04.033 

Wolf E, Rich NE, Marrero JA, et al. Utilization of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis. Hepatology. Published online May 8, 2020;10.1002/hep.31309. doi:10.1002/hep.31309

Farvardin S, Patel J, Khambaty M, et al. Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis. Hepatology. 2017;65(3):875-884. doi:10.1002/hep.28770