Long-COVID may not be the only global pandemic hangover for the Australian healthcare system. There are growing reports of weight gain in the community and increased alcohol consumption during the pandemic. If such patterns are sustained, they could have significant impacts on chronic disease in coming years, including liver cancer.
Liver cancer is one of the most rapidly growing cancer types in Australia in terms of both incidence and mortality. The growing burden of liver cancer has come into the spotlight during COVID-19 with a new focus on two associated preventable risk factors – alcohol consumption and obesity.
A new Prevention Centre research project is conducting innovative modelling to help predict health outcomes and costs of liver cancer surveillance in cirrhotic patients.
Lead investigator, Dr Eleonora Feletto said the ‘suspended reality’ of the COVID era may be a chance for the community to reassess their risk factors. However, there is still a disconnect in thinking.
“Obesity and high alcohol use are both associated with many cancers but because there is a long lag time it can be overlooked,” she said. “This is especially so when it comes to liver cancer. Despite it having one of the poorest survival rates, many patients are not diagnosed until they have incurable late-stage disease.”
Dr Feletto leads the Gastrointestinal Cancers Policy and Evaluation stream of research at the Daffodil Centre. The new Prevention Centre project Preventing liver cancer: Obesity and alcohol consumption will focus on people at high risk of liver cancer rather than on primary prevention of risk factors associated with liver cancer.
The most common type of liver cancer is hepatocellular carcinoma (HCC), typically developing from liver disease such as fibrosis and cirrhosis. Alcohol-related liver disease (ARLD) and non-alcoholic fatty liver disease (NAFLD; now also referred to as metabolic-associated fatty liver disease) are precursor conditions for liver cirrhosis and are associated with common preventable lifestyle risk factors. Prolonged excess alcohol consumption can cause liver damage and result in ARLD, while obesity is associated with an increased risk of NALFD.
Given the biological pathway of liver cancer and clearly defined high-risk groups, there is potential for early detection through liver cancer control interventions to reduce the disease burden. Promising evaluations of high-risk cirrhotic patients with evidence of improved early-stage diagnosis and survival have led to the development of the Policy1-Liver predictive model to mathematically map health outcomes for high-risk patients with cirrhosis.
As well as supporting screening and early detection interventions, predictive modelling tailored to the Australian setting could be used to support optimal recommendations for specific patient subgroups and evaluate the cost-effectiveness of any future programs.
“This is the first time a tailored model building on local and international evidence is being developed for the Australian context,” Dr Feletto said. “Our project plans to expand the scope of this liver cancer predictive model to predict the health outcomes and costs of HCC surveillance in cirrhotic patients. It will provide an evidence base to support recommendations for future liver cancer control interventions and incorporate a prevention lens.”
The project, due for completion in early 2023, will help determine the Australian prevalence of excessive alcohol consumption or obesity and evaluate the impact of excessive alcohol consumption or obesity on liver cancer. This could guide future investment in liver cancer control and help reduce the burden in Australia.