Patient and physician expectations regarding disease and treatment of advanced HCC: The prospective PERCEPTION1 study

Abstract

BackgroundWe aim to explore patient expectations regarding their treatments and prognosis in comparison to physicians' assessments in patients with advanced hepatocellular carcinoma (HCC) receiving systemic treatments. MethodsWe prospectively enrolled 205 patients in France and Belgium with BCLC B/C HCC receiving systemic treatment (NCT04823754). Patients completed a 28-question survey and Hospital Anxiety and Depression Scale (HADS), while physicians filled a 17-question survey after the initial consultation. Univariate and multivariate models were used to assess factors associated with concordant patient-physician responses, HADS, predicted (by physicians) and observed overall survival. ResultsPatients had a median age of 68 years with 75% of BCLC C HCC; 86.3% received atezolizumab/bevacizumab. 60% of patients didn't discuss life expectancy with the physician. 63% of the patients believed they had a life expectancy > 5 years. Among shared questions between patients and physicians, 36.4% of concordance was observed; major differences centered on life expectancy with patients more optimistic than physicians. A lower patient-physician concordance was seen with shorter-consultations (p=0.003), female physicians (p=0.02), BCLC C (p=0.03) and >100 HCC patients/year per physician (p=0.008). Compared to France, patients from Belgium have more satisfaction about the consultation (p<0.001) but were less optimistic about life expectancy. Using HADS, 52% of the patients have anxiety/depression that was correlated with AFP (p=0.03). The predicted median overall survival by physician was 18 months versus 13 months for the observed overall survival (weak correlation, ρ=0.31). ConclusionExpectations regarding systemic treatments for advanced HCC differ significantly between patients and physicians, showing notable variations across countries. Impact and implicationsThis multicentric prospective study, conducted in France and Belgium, focuses on patients with advanced HCC undergoing systemic treatments. The findings of our study underscore the disparities in expectations regarding systemic treatments for advanced HCC between patients and physicians, revealing also significant variations between France and Belgium. These results suggest the need for targeted interventions aimed at enhancing patients' comprehension of their disease and fostering better communication between patients and physicians Clinical trial numberNCT04823754