HCC Surveillance Rates Declined During COVID-19 and Remain Low in the Post-Pandemic Era

Key Takeaways:

• During the COVID-19 pandemic, 6-month hepatocellular carcinoma (HCC) surveillance decreased from 30.8% to 21.1%. Rates have still not risen, with only 22.3% of patients with cirrhosis undergoing HCC surveillance post-pandemic.
• A similar decline was observed for 12-month HCC surveillance. During the pandemic, HCC surveillance decreased from 40.6% to 31.4% and remained at 30.1% in the post-pandemic period.
• HCC surveillance declined across all racial and insurance subgroups. However, patients without insurance or who were covered by indigent care had the lowest rates of HCC surveillance, exposing a significant gap in care and early intervention.

The COVID-19 pandemic led to major disruptions in health care due to the decline of in-person visits, particularly for cirrhosis care and HCC surveillance. Regular HCC surveillance is linked to early detection and improved patient outcomes, making it a significant aspect of care. Health visits have mostly returned to normal, so a study sought to determine if HCC surveillance rates have returned to pre-pandemic levels, specifically for safety-net populations.

A retrospective cohort study was conducted across 5 US safety-net health systems for adults with cirrhosis. HCC surveillance was observed across 3 time periods: March 1, 2018, to February 29, 2020 (pre-pandemic); March 1, 2020, to February 28, 2022 (pandemic period); and March 1, 2022, to February 29, 2024 (post-pandemic).

The Pandemic’s Impact on HCC Surveillance

Among the 6940 patients with cirrhosis identified in the study, 1940 (30.8%) underwent 6-month HCC surveillance in the pre-pandemic period. This number declined to 1468 patients (21.1%) during the pandemic and remained low at 1405 patients (22.3%) in the post-pandemic period.

A similar trend was observed for 12-month HCC surveillance as well. Out of 6940 patients, 2426 (40.6%) underwent surveillance in the pre-pandemic period, which declined to 2066 patients (31.4%) during the pandemic. Rates of surveillance did not rebound and instead remained low at 1807 patients (30.1%) in the post-pandemic period.

Declines of HCC surveillance were similar across multiple racial groups. White, African American, and Hispanic patients experienced declines in HCC surveillance during the pandemic which did not rebound during the post-pandemic period. Asian patients, however, experienced an initial decline but rebounded during the post-pandemic period, although the subgroup’s small size does not make this statistic noteworthy.

Patients with insurance had the highest rates of HCC surveillance across all 3 time periods, although patients across all insurance types still experienced declines which did not rebound after the pandemic ended. HCC surveillance was the lowest among patients who had no insurance or were covered by indigent care, with only 1 in 9 patients undergoing HCC surveillance in the post-pandemic period. This particular finding highlights the need for increased intervention and expanded access for safety-net populations.

Implications for Managed Care

The study’s findings reveal that since the pandemic, HCC surveillance remains alarmingly low among safety-net populations, with 1 in 4 patients with cirrhosis undergoing HCC surveillance. The authors urge immediate intervention and strategies aimed at closing this gap as HCC surveillance is vital to improving patient outcomes.

The authors said, “Urgent action is needed to implement novel and effective interventions to improve HCC surveillance to prevent the downstream consequences of advanced tumor stage, limited treatment options, and high mortality.”

Reference

Wong RJ, Jones P, Niu B, et al. Pandemic-related disruptions and hepatocellular carcinoma surveillance in safety-net settings. JAMA Netw Open. 2026;9(5):e2614345. doi:10.1001/jamanetworkopen.2026.14345