Hashmi Irma N, Lee Hannah M, Wedd Joel P, Sterling Richard K, Dulong-Rae Teri E, Cassel J Brian, Cyrus John W, Fletcher James J, Noreika Danielle M
Division of Gastroenterology, Hepatology, and Nutrition, VCU Health System, Richmond, VA, USA.
Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University, Richmond, VA, USA; Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA; Hume-Lee Transplant, Virginia Commonwealth University, Richmond, VA, USA.
Ann Palliat Med. 2023 Nov;12(6):1260-1274. doi: 10.21037/apm-23-416. Epub 2023 Aug 21.
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths, and case numbers continue to rise in the United States. HCC carries a poor prognosis, and management requires a multidisciplinary approach. This narrative review aims to identify opportunities for further integration of palliative care (PC) in HCC care. Given the high symptom burden faced by patients with HCC, early PC consultation can be beneficial for patients.
A search of PubMed was conducted from inception of the database to March 1, 2023. The search was composed of keywords and controlled vocabulary terms for concepts related to palliative medicine and symptom management in the setting of HCC.
This narrative review finds that although PC has been integrated into HCC guidelines, partnerships between PC and hepatology are still nascent in clinical practice. Treatment-related barriers pose a challenge to timely integration of PC in the care of HCC patients; evaluation or listing for transplantation can be perceived as a barrier to PC consultation, and unpredictable clinical courses make prognostication challenging. Providers may hesitate to pursue PC referral due to a lack of consensus around the role of PC, and for those that are referred, timing of consultation remains an issue, especially for those who are potential liver transplant candidates. There are few studies of PC in HCC, limiting evidence-based recommendations that can be made regarding PC involvement in this patient population.
While PC is not routinely integrated into HCC care, recent guideline recommendations and a growing number of studies may change this over time. Although further evidence is needed, PC and hepatology teams partnering together can explore ways to improve the care of this patient population. PC consultation early in HCC care could assist in management of symptom relief, psychosocial and spiritual support, and caregiver support. Effective communication will be required to set parameters for referral and clarify potential outcomes of consultation. Teams should be prepared for the challenges involved in a culture change and paradigm shift in clinical practice.
肝细胞癌（HCC）仍是癌症相关死亡的主要原因，且在美国病例数持续上升。HCC预后较差，其治疗需要多学科方法。本叙述性综述旨在确定在HCC治疗中进一步整合姑息治疗（PC）的机会。鉴于HCC患者面临的高症状负担，早期PC会诊对患者可能有益。
对PubMed数据库自创建至2023年3月1日进行检索。检索由与HCC背景下姑息医学和症状管理相关概念的关键词和控制词汇组成。
本叙述性综述发现，尽管PC已被纳入HCC指南，但在临床实践中，PC与肝病学之间的合作仍处于起步阶段。与治疗相关的障碍对PC及时整合到HCC患者护理中构成挑战；评估或列入移植名单可能被视为PC会诊的障碍，且不可预测的临床病程使预后判断具有挑战性。由于对PC作用缺乏共识，医疗服务提供者可能会犹豫是否进行PC转诊，而对于那些被转诊的患者，会诊时机仍然是一个问题，尤其是对于那些可能成为肝移植候选者的患者。关于HCC中PC的研究很少，限制了针对PC参与该患者群体可提出的循证建议。
虽然PC未常规纳入HCC护理，但近期的指南建议和越来越多的研究可能会随着时间的推移改变这种情况。尽管还需要进一步的证据，但PC和肝病学团队合作可以探索改善该患者群体护理的方法。在HCC护理早期进行PC会诊有助于缓解症状、提供心理社会和精神支持以及照顾者支持。需要有效的沟通来设定转诊参数并阐明会诊的潜在结果。团队应准备好应对临床实践中文化变革和模式转变所涉及的挑战。
