Table 1 Strategies for comprehensive liver cancer control

Access to treatments

Appropriate coverage and reimbursement for necessary prevention, surveillance, treatment, pain relief and palliative services.

"Creating access to treatment-screening is a waste of effort if you don't link it to care"

"The national insurance system does not fully cover payment"

"Patients ask for new treatments, however, they are not covered by insurance"

"It is important to eradicate drug lag and make good medication available as soon as possible"

Centers of excellence

Specialized liver cancer centers to provide coordinated surveillance, treatment and research within a national liver cancer program.

"Transfer patients with a HCC diagnosis to a tertiary hospital to receive state-of-the-art treatment"

"There is no organization that brings all liver cancer research together under one roof"

"Build a large center, experienced with international techniques, with a large number of patients"

"We need to continue to preach to establish centers of excellence with multidisciplinary efforts"

Clinical education

Improve primary care provider's awareness of the benefits of screening and early treatment, and necessary skills in risk assessment.

"Most of the educational resources need to go into educating healthcare professionals"

"Increase awareness among general practitioner, most are not aware"

"Education of general practitioners concerning the screening of HCC, and gastroenterologists too"

"We need to focus on the general education for primary care physicians so they will become vigilant"

Measuring social burden

Accurate measures of risk factors, cirrhosis, liver cancer, the societal costs of illness and the benefits of improving liver cancer care.

"Research the epidemiology of liver cancer, I think that we underestimate liver cancer by 50%"

"Prevalence, surveillance, burden of disease, effective and cost-effective strategies"

"Know the epidemiological trend for non-alcohol fatty liver disease and its impact on HCC incidence"

"We need to have some comparison about how many lives we can save if we improve"

Monitoring of at-risk populations

National surveillance programs for at-risk patients through expert services to diagnose HCC in early stages and improve outcomes.

"Get at-risk patients into adequate screening programs at appropriate intervals and tested by experts"

"Of cause surveillance programs are important to prevent or to detect early HCC"

"There should be a national surveillance program for liver cirrhosis"

"Monitor high-risk patients so if they develop HCC they can be diagnosed at an early stage and treated"

Multidisciplinary management

Diagnosis, treatment decisions and follow-up of all HCC patients through collaborative teams of all relevant specialists.

"Follow-up of HCC patients should be in a multidisciplinary team of different specialists"

"Collaboration among physicians, surgeons, radiologists and oncologists is very poor"

"Create an appropriate interdisciplinary board where every single patient is evaluated by this team"

"It is very important to appreciate that this disease is heterogeneous with regards to the etiology"

National guidelines

National standards for diagnosis and guidelines for screening, surveillance, treatment and palliation related to liver cancer.

"There are no national guidelines on how to deal with patients with liver cancer"

"There should be a national treatment strategy recognized and outcomes captured"

"There is a lack of standardization of clinical diagnosis and treatment"

"Information exchange among world leaders to prepare a global standard for prevention and treatment"

Public awareness

Programs to improve public/political awareness about risk factors, surveillance, and survival benefits, and organized patient advocacy.

"Greater public awareness of liver disease, risk factors and the fact that good treatments are available"

"There is an absolute ignorance among the public and there is a clear need for education"

"Patient groups are limited to popular types of cancer, but HCC is mainly the cancer of the poor"

"Support experts to handle the details of patient advocacy so prevention and treatment could benefit"

Research infrastructure

Funding, personnel, and facilities to conduct relevant basic, clinical and translational liver cancer research throughout the health system.

"There is no specific program for HCC with public funding ... research infrastructure is always needed"

"Train physicians who can lead clinical trials ... we also need research nurses"

"Get thorough scientific research for HCC, genetics, biology, the pathways, it is very important"

"There is an uneven distribution of research funding and the lack of grass-roots research funding"

Risk-assessment and referral

Risk stratification conducted by primary care providers who refer patients to appropriate surveillance provided regularly by experts.

"Identify at-risk patients, encourage them to be screened, and link them to appropriate care"

"Primary doctors should not be treating viral hepatitis, they should be detecting it"

"GPs don't consider it necessary and don't perform screening in patients with diagnosed cirrhosis"

"We have very inefficient tools for identifying the high risk patients"

Transplantation infrastructure

Improve awareness and capacity for organ donation, more capacity for transplantation, and alternatives to cadaveric transplantation

"The situation cannot be altered without donors, but there is not much social infrastructure to support it"

"It has been a major necessity to promote more cadaveric liver transplantation for more than decade"

"The only shortcoming is transplantation, cadaveric transplantation is standard in other countries"

"Real awareness of organ donation. There are some examples in the media, but still nothing happens".