Division of Hepatology, Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Palliat Med. 2023 Mar;26(3):334-341. doi: 10.1089/jpm.2022.0338. Epub 2022 Sep 23.
Patients with hepatocellular cancer (HCC) are at risk for poor quality of life (QoL) and high symptom burden, coupled with limited treatment options. Palliative care (PC) can play an important role in reducing the suffering of this population, but remains underutilized. To demonstrate feasibility of an outpatient PC intervention within HCC care. This is a pilot randomized controlled trial conducted at an academic center. All stages of HCC patients (except Barcelona Clinic Liver Cancer stage D) with a scheduled hepatology appointment were eligible. Patients were randomized to receive PC intervention or usual care (control arm). In the PC arm, patients received PC from a PC provider at enrollment and at three months from the baseline visit, in addition to continued standard of care. Control arm received only standard care. All patients completed FACT-Hep (Functional Assessment of Cancer Therapy-Hepatobiliary Cancer) and modified Edmonton Symptom Assessment Scale at baseline and at three-month visit. Descriptive statistics were utilized to summarize questionnaires, and change in QoL and symptoms from baseline to three months were compared between the two study groups. Of the 109 approached, 57 patients (52.3%) consented to enroll, and 52 (91%) completed the study. QoL and symptom burden assessments demonstrated impaired QoL and high symptom burden in both arms of the study. At least 50% of enrolled patients in each arm had some degree of fatigue, pain, sleep disturbance, and appetite loss, at baseline. Post-intervention, symptom burden and QoL improved in the intervention arm and remained same or worsened in the control group. All FACT-Hep scores decreased numerically among controls and increased numerically among patients in the PC intervention group. Outpatient PC intervention within routine HCC care is feasible, and can potentially improve QoL and symptoms.
患者患有肝细胞癌 (HCC)，生活质量 (QoL) 差，症状负担重，治疗选择有限。姑息治疗 (PC) 可以在减轻这部分人群的痛苦方面发挥重要作用，但仍未得到充分利用。本研究旨在展示 HCC 治疗中门诊 PC 干预的可行性。这是在学术中心进行的一项试点随机对照试验。所有阶段的 HCC 患者（巴塞罗那临床肝癌分期 D 除外），只要有计划的肝病预约，都符合条件。患者被随机分配接受 PC 干预或常规护理（对照组）。在 PC 组中，患者在入组时和基线就诊后三个月接受 PC 治疗，同时还接受标准护理。对照组仅接受标准护理。所有患者在基线和三个月时均完成 FACT-Hep（癌症治疗功能评估-肝胆癌）和改良 Edmonton 症状评估量表。采用描述性统计来总结问卷，并比较两组患者从基线到三个月时 QoL 和症状的变化。在 109 名被接触的患者中，有 57 名（52.3%）同意入组，其中 52 名（91%）完成了研究。QoL 和症状负担评估显示，研究组的两组患者的 QoL 都受损，症状负担都很高。在基线时，每组至少有 50%的入组患者存在一定程度的疲劳、疼痛、睡眠障碍和食欲下降。干预后，干预组的症状负担和 QoL 有所改善，而对照组则保持不变或恶化。对照组的所有 FACT-Hep 评分均呈数值下降，而 PC 干预组的患者评分均呈数值上升。在常规 HCC 治疗中开展门诊 PC 干预是可行的，并且有可能改善 QoL 和症状。
