Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy.
Palliat Med. 2024 Oct;38(9):1033-1041. doi: 10.1177/02692163241269794. Epub 2024 Aug 28.
Delays and limitations of palliative care in patients with liver transplantation- 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.
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.
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- end-stage hepatocellular carcinoma.
Physician members of the of the two associations, representing several hospitals and services in the country.
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.
This survey highlights significant differences in the approach to patients with liver transplantation- end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.
根据巴塞罗那临床肝癌分期系统，肝移植终末期肝细胞癌患者的姑息治疗存在延迟和限制，这可能是由于肝内科医生和姑息治疗医生之间缺乏共识指南，导致观念不同所致。
评估肝内科医生对终末期肝细胞癌姑息治疗的态度，并了解在缺乏共识指南的情况下，影响姑息治疗与肝内科医生更有效管理合作的障碍。
邀请意大利肝病研究协会和意大利姑息治疗学会的成员参加一项基于网络的调查，以研究肝移植终末期肝细胞癌患者的实际管理态度。
该调查的参与者为这两个协会的医生成员，代表了该国的几家医院和服务机构。
97 名肝内科医生和 70 名姑息治疗医生完成了这项调查：超过 80%的人定期随访 1-19 名患者；58%的肝内科医生在患者管理方面与姑息治疗医生合作，55%的姑息治疗医生在没有肝内科医生协助的情况下照顾患者。在肝硬化的管理方面，两组之间在白蛋白、胃镜、抗病毒治疗、抗凝、穿刺放液指征和肝性脑病管理方面存在显著差异。肝内科医生广泛使用全剂量乙酰氨基酚，而两种类别（肝内科医生和姑息治疗医生）的医生都经常使用阿片类药物，无论肝功能如何，都使用全剂量。
这项调查突出了肝移植终末期肝细胞癌患者管理方法的显著差异，强调了制定共识指南和进一步研究姑息治疗的必要性。
