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

BACKGROUND

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.

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- 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- end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.