Multidisciplinary team management of hepatocellular carcinoma in the MENA region: current practices, challenges, and gaps

Abstract

Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a high disease burden in the Middle East and North Africa (MENA) region. Multidisciplinary teams (MDTs) are essential for optimizing HCC management; however, their implementation and impact may vary across healthcare settings. This study evaluates the structure, decision-making processes, and challenges faced by MDTs in HCC treatment centers across the MENA region. Patients and Methods: This cross-sectional, multicenter study surveyed representatives from 53 HCC treatment centers across 38 cities in 11 MENA countries. A structured questionnaire was electronically distributed to assess MDT composition, meeting frequency, decision-making processes, adherence to clinical guidelines, patient management pathways, and challenges in HCC treatment. Results: Among the surveyed centers, 84.9% (n=45) reported having an established MDT. The most common specialties involved in MDT composition were hepatology (100%), interventional radiology (97.8%), medical oncology (91.1%), and hepatobiliary surgery (80%). Barcelona Clinic Liver Cancer staging was used in 95.6% of centers. Despite acknowledging MDT benefits, major challenges were documented by participants, including resource limitations (13.2%), financial constraints (13.2%), patient nonadherence (9.4%), and limited access to advanced technology (11.3%). Telemedicine was underutilized (9.4% of centers), and only 15.1% experienced participation in clinical trials. Conclusion: Our result highlights the pivotal role of MDTs in HCC management in the MENA region, demonstrating adherence to evidence-based guidelines and exposing critical gaps in resource availability, technology integration, and patient-centered decisionmaking. Strengthening MDTs through enhanced resource allocation, digital health adoption, and increased clinical trial participation is essential to improving HCC outcomes in the region.