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 decision-making. Strengthening MDTs through enhanced resource allocation, digital health adoption, and increased clinical trial participation is essential to improving HCC outcomes in the region. Plain Language Summary: This study identifies critical gaps in multidisciplinary hepatocellular carcinoma (HCC) management across the Middle East and North Africa (MENA). Despite recognizing multidisciplinary teams’ value, inconsistent implementation, fragmented referral pathways, limited diagnostic tool accessibility, and insufficient public awareness significantly hinder optimal patient care. Addressing these gaps urgently requires integrated national policies, expanded diagnostic infrastructure, enhanced clinician training, structured referral systems, and stronger public and patient engagement strategies. The study underscores the necessity for a strategic, coordinated approach to improve clinical outcomes and reduce the healthcare burden of HCC in the region.