studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 479A
reflect the position or policy of the Department of Veterans
Affairs or the United States government.
Disclosures:
Christine M. Hunt - Consulting: Otsuka
Ayako Suzuki - Consulting: Novartis
Hans L. Tillmann - Consulting: Novartis; Employment: AbbVie; Grant/Research
Support: Novartis; Stock Shareholder: AbbVie, Abbott, Gilead
Joseph K. Lim - Consulting: Merck, Boehringer-Ingelheim, Gilead, Bristol Myers
Squibb, Janssen; Grant/Research Support: AbbVie, Boehringer-Ingelheim, Bristol
Myers Squibb, Gilead, Hologic, Janssen
The following authors have nothing to disclose: Lauren A. Beste, George N.
Ioannou, Elliott Lowy, Dawn T. Provenzale, Michael J. Kelley, Cynthia A. Moylan,
Omobonike O. Oloruntoba, David Ross
541
Comparable hepatitis C treatment outcomes with oral
direct-acting antivirals between rural outreach clinics
and an academic medical center: A case for expanding
task-shifting
Channa R. Jayasekera, Ryan B. Perumpail, Aijaz Ahmed; Division
of Gastroenterology and Hepatology, Stanford University Medical
Center, Stanford, CA
Purpose: Residence in medically underserved areas is associated
with lower likelihood of receiving hepatitis C treatment.
The safety, tolerability, and effectiveness of oral direct-acting
antivirals (DAA) may obviate the need for specialist expertise
in many patients, and decentralizing treatment from specialists
to more abundant community-based providers may improve
treatment access without compromising safety. At our rural
outreach clinics (OCs), a visiting hepatologist evaluates treatment
eligibility but subsequent routine management is devolved
to licensed vocational nurses (task-shifting). The hepatologist
reviews laboratory results remotely and is available for consultation
and as-needed clinic visits. We assessed the outcomes
of patients treated at these OCs versus those treated directly
by the hepatologist at an academic medical center (AMC).
Methods: We retrospectively compared clinical characteristics,
sustained virological response 12 weeks after treatment completion
(SVR12) rates, treatment discontinuation and adverse
event rates of consecutive patients treated with DAAs by a
single hepatologist between Dec 2013-Sept 2014 at an AMC
and three OCs. Results: 45 AMC and 48 OC patients received
either sofosbuvir+ribavirin (SOF+RBV) or sofosbuvir+simeprevir
(SOF+SMV). AMC and OC patients were comparable in
age, gender, HCV genotype distribution, and prior treatment
experience. More AMC patients were cirrhotic (73.3% vs
50%, p=0.03) and received SOF+SMV (77.8% vs. 56.3%,
p=0.03). Overall SVR12 rates were comparable between the
AMC and OCs (88.8% vs. 83.3%, p=0.87), as were SVR12
rates of non-cirrhotic, cirrhotic, treatment-naïve, treatment-experienced,
genotype 1, 2, and 3 patients (figure 1). One patient
discontinued treatment at each site. There were no treatment
related hospitalizations or deaths. Conclusions: In this analysis
of oral DAA therapy at rural outreach clinics and an academic
medical center, treatment responses were comparable to published
real-world data, and site of treatment or type of provider
did not impact treatment outcome. This task-shifting strategy,
wherein mid-level providers are empowered to manage HCV
treatment in medically underserved areas with remote supervision
of specialists, may hold promise in expanding HCV treatment
access.
Disclosures:
Aijaz Ahmed - Consulting: Bristol-Myers Squibb, Gilead Sciences Inc., Roche,
AbbVie, Salix Pharmaceuticals, Janssen pharmaceuticals, Vertex Pharmaceuticals,
Three Rivers Pharmaceuticals; Grant/Research Support: Gilead Sciences
Inc.
The following authors have nothing to disclose: Channa R. Jayasekera, Ryan B.
Perumpail
542
Reducing Wait Times for Radiofrequency Ablation in
Patients with Hepatocellular Carcinoma: A Quality
Improvement Initiative at the Toronto Centre for Liver
Disease.
Mayur Brahmania 1 , Osman Ahmed 1 , Korosh Khalili 2 , Eberhard L.
Renner 1 , Harry L. Janssen 1 , Morris Sherman 1 , David K. Wong 1 ,
Hemant Shah 1 , Jordan J. Feld 1 ; 1 Gastroenterology, University of
Toronto, Toronto, ON, Canada; 2 Medical Imaging, University of
Toronto, Toronto, ON, Canada
Introduction: Radiofrequency ablation (RFA) has become the
recommended curative treatment option for patients with early
stage hepatocellular carcinoma (HCC). Unfortunately, the
expected number of HCC cases requiring RFA will grow at a
greater rate than potential RFA capacity. Thus, novel strategies
will be required to handle the burden. According to guidelines,
waiting times for any malignancy from diagnosis to treatment
should not exceed 30 days. In the current analysis we investigated
if wait times for RFA were associated with outcomes such
as residual disease after RFA, tumor recurrence, liver transplant
or death. Methods: This was a retrospective study analysing
patients with HCC between January 2012 and December
2014 presenting to University Health Network (UHN) hospitals
in Toronto. Multi-disciplinary Tumor Board rounds were held
weekly on patients with newly diagnosed HCC. All patients
receiving RFA alone as treatment for HCC were included. The
time from diagnosis to presentation at Tumor Board rounds
and the time from Tumor Board rounds to the date the patient
received first treatment was documented. Multivariable Cox
regression was used to determine factors associated with tumor
outcome. Results: Of the 150 patients included in the study,
82% percent were male and the median age was 62 years
(Range 25-90). Median tumor size at diagnosis was 19 mm
(Range 0-43 mm), mean MELD was 7 (SD=4.3) and 58% had
Barcelona stage A. The cause of liver disease was hepatitis C
in 41%, hepatitis B in 30%, Hepatitis B/C co-infection in 2%,
and other liver diseases in 27%. The median wait time from
diagnosis to Tumor Board presentation was 21 days (range
12-41), wait time from Tumor Board to Interventional Radiology
consultation was 30 days (21-48) and the mean time from
consultation to RFA was 44 days (IQR 34-58). The median
time from HCC diagnosis to RFA treatment was 98 days (IQR
79-139). 30 patients died or underwent transplant. When
adjusting for Barcelona staging, tumor size and MELD score,
wait times >150 days was not associated with an increased
risk of death or transplant (HR=1.69; p=0.23). Conclusion:
Our study demonstrates wait times for RFA in patients with HCC
are over the recommended waiting time in our province. Wait
times over 150 days showed a non-significant trend towards