Optimal timeframes & summary
Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Hepatocellular Carcinoma (HCC) Working Group.
Timeframes for care
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Step in pathway |
Care point |
Timeframe |
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Screening – Patients deemed at risk of HCC should participate in screening and follow the National Hepatocellular Carcinoma Consensus Statements |
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Presentation, initial investigations and referral |
Signs and symptoms |
Presenting symptoms should be promptly and clinically triaged with a health professional |
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Initial investigations initiated by GP |
Tests should be conducted within 2 weeks of patients presenting with symptoms |
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Referral to specialist |
Patients should see a specialist linked to a multidisciplinary team within 2 weeks of GP referral |
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Diagnosis, staging and treatment planning |
Diagnosis and staging |
Investigations should be completed within 4 weeks of the initial referral |
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Multidisciplinary meeting and treatment planning |
Within 2 weeks of finding a suspected HCC, patients should be referred to a specialist multidisciplinary team where possible; the team should have a rapid access program or contact person |
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Treatment |
Surgery (resection or transplant) |
Treatment should begin within 4 weeks of the MDM |
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Local ablative therapies |
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Regional therapies |
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Localised therapies |
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Seven steps of the optimal care pathway
Step 1: Prevention and early detection
Step 2: Presentation, initial investigations and referral
Step 3: Diagnosis, staging and treatment planning
Step 4: Treatment
Step 5: Care after initial treatment and recovery
Step 6: Managing recurrent, residual or metastatic disease
Step 7: End-of-life care
There is an increasing burden of HCC worldwide, driven by ageing cohorts of people with chronic hepatitis C virus (HCV), the increased burden of non-alcoholic fatty liver disease related to the obesity epidemic, high levels of immigration of people from endemic hepatitis B virus (HBV) countries and suboptimal HBV/HCV screening. These factors, combined with continued low levels of antiviral therapy intervention, lead to a marked increase in HCC cases (Calzadilla-Bertot et al. 2018; Dore 2012; Hong et al. 2015, Mittal & El-Serag 2013).
Viral hepatitis is the leading cause of HCC in Australia. The latest surveillance data indicates that there are more than 170,000 Australians living with chronic hepatitis C and 210,000 with chronic hepatitis B (The Kirby Institute 2019). In 2013, there were more than 1,000 lives lost due to viral hepatitis, many related to liver cancer as a complication of chronic infection with either HBV or HCV (The Kirby Institute 2014).
