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Deborah (Debi) A. Boyle MSN, RN, AOCNS, FAAN, is editor in chief of Oncology Nursing News®. She is a long tenured oncology clinical nurse specialist who has practiced in both Comprehensive Cancer Centers and community cancer programs. A frequent speaker nationally and abroad, Debi is the recipient of numerous honors and has published more than 330 articles, chapters, monographs, editorials, blogs, and books. A writer, editor, and speaker, Debi is dedicated to advancing quality nursing education and practice within cancer care.

The Changing Face of Hepatocellular Carcinoma

Some groups are more prone to the disease than others.
PUBLISHED: 1:40 PM, FRI MARCH 15, 2019
Hepatocellular carcinoma (HCC) accounts for many deaths worldwide each year. Major risk factors for this malignancy include chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), with resultant chronic liver disease and cirrhosis.1 Unlike the majority of cancers, the cause of this malignancy is often known. Worldwide, the implementation of vaccination initiatives has resulted in a dramatic reduction of chronic infections known to cause HCC. Yet incidence rates remain problematic in certain parts of the world.

In the California, Asian Americans are the fastest-growing minority group and they bear a disproportionate burden of HCC.2 Yet, the future portends increasing problems. HCV infection is more prominent among the “Baby Boomer” Asian subgroups who were likely exposed to this infection in the 1970s and 1980s.3 As a result, a heightened number of older Asian Americans are likely to be diagnosed in the coming years.

A recent detailed analysis of HCC in California provided important information about this malignancy’s future projections.4 Acknowledging that one third of Asian Americans reside in this state, the demographics of this malignancy will be increasingly revealed. It is very likely that this ethnic minority of those afflicted with HCC will evolve into an oncologic majority requiring intensive screening and education to those at risk. This presents numerous opportunities for oncology nurses to engage in public health initiatives.


References:
  1. Ryerson AB, Eheman CR, Altekruse SF et.al. (2016). Annual report to the nation on the status of cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer, 122(9): 1312-1337.
  2. Pham C, Fong TL, Zhang J, Liu L (2018). Striking racial/ethnic disparities in liver cancer incidence rates and temporal trends in California, 1988-2012. J Natl Cancer Inst, 110(11): djy051. Doi: 10.1093/jnci/djy051.
  3. Boyle DA (2017). Hepatocellular carcinoma: Implications for Asia-Pacific oncology nurses. Asia Pac J Oncol Nurs, 4: 98-103.
  4. Han SS, Kelly SP, Yuqing L et.al. (2018). Changing landscape of liver cancer in California: A glimpse into the future of liver cancer in the United States. J Natl Cancer Inst, 111(6): djy180. Doi: 10.1093/jnci/djy180.


Education Resources for HCV Infection:
American Liver Foundation. http://hepc.liverfoundation.org
Centers for Disease Control and Prevention ((CDC). http://cdc.gov/hepatitis/C/PatientEduC.htm
American College of Gastroenterology. http://patients.gi.org/topics/hepatitis-c
Hepatitis Foundation International. http://www.hepfi.org/RESOURCES/Links.html
Source: Resources for HCV infection. Nursing 2015. 45(7): 68.
 

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While we should often dive deeper and ask the next question, we should also facilitate the patient and family to do the same with us.
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There are multiple reasons why patients decide not to participate in clinical trials, and it is essential that healthcare providers understand them to overcome barriers.
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