Palliative care in patients with hepatocellular carcinoma: Results from a survey among hepatologists and palliative care physicians

• Published in: Palliative medicine Vol. 38; no. 9; pp. 1033 - 1041
• Main Authors: Iavarone, Massimo, Canova, Lorenzo, Alimenti, Eleonora, Aghemo, Alessio, Taveggia, Diego, Gobber, Gino, Cabibbo, Giuseppe, Veronese, Simone, Calvaruso, Vincenza, Orsi, Luciano, Caraceni, Paolo, Lampertico, Pietro
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2024; Sage Publications Ltd
• Subjects: Adult; Aged; Attitude of Health Personnel; Attitudes; Carcinoma, Hepatocellular - therapy; Dosage; Encephalopathy; Female; Gastroenterologists; Hepatology; Hospitals; Humans; Italy; Liver cancer; Liver cirrhosis; Liver diseases; Liver Neoplasms - therapy; Liver transplants; Male; Middle Aged; Opioids; Palliative Care; Patients; Physicians; Physicians - psychology; Polls & surveys; Practice Patterns, Physicians' - statistics & numerical data; Proteins; Surveys and Questionnaires; Transplants; Italy; Liver cancer; pain; liver transplantation; cirrhosis; albumin
• ISSN: 0269-2163; 1477-030X; 1477-030X
• DOI: 10.1177/02692163241269794

Background: Delays and limitations of palliative care in patients with liver transplantation-ineligible end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines. Aim: To assess physicians’ attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists. Design: Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-ineligible end-stage hepatocellular carcinoma. Participants: Physician members of the of the two associations, representing several hospitals and services in the country. Results: Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1–19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function. Conclusions: This survey highlights significant differences in the approach to patients with liver transplantation-ineligible end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.