Christopher D Woodrell1, Lissi Hansen2, Thomas D Schiano3, Nathan E Goldstein4. 1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York. Electronic address: christopher.woodrell@mssm.edu. 2. School of Nursing, Oregon Health and Science University, Portland, Oregon. 3. Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Abstract
PURPOSE: Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, has a rapidly rising prevalence in the United States and a very poor overall rate of survival. This epidemic is driven by the cohort of aging Baby Boomers with hepatitis C viral infection and the increasing prevalence of cirrhosis as a result of nonalcoholic steatohepatitis. Because curative options are limited, the disease course creates, in patients and their families, distressing uncertainty around prognosis and treatment decisions. Older adults are disproportionately affected by HCC and have more comorbidities, adding to the complexity of the disease. This population would benefit from increased access to palliative care services, which can potentially complement the treatments throughout the disease trajectory. The purpose of this review was to use existing evidence to propose a new model of palliative care integration in patients with HCC. Thus, we focus on the HCC stage and the treatment algorithm, the ways that palliative care can offer support in this population at each stage, as well as elements that can enhance patient and family support throughout the entire disease trajectory, with an emphasis on the care of older adults with HCC. METHODS: This is a narrative review in which we identify evidence-based ways that palliative care can help younger and older adults with HCC and their families, at each stage of HCC and throughout the disease trajectory. FINDINGS: We propose ways to integrate HCC and palliative care based on the existing evidence in both fields. Palliative care offers support in symptom management, advanced care planning, and decision making in ways that are specific to each stage of HCC. We also discuss the evidence that illustrates the palliative care needs of patients with HCC that span the entire course of illness, including coping with the stigmatization of liver disease, addressing informational needs at different stages, and discussing quality of life longitudinally. IMPLICATIONS: Integrating palliative care into the treatment of patients with HCC has the potential to improve outcomes, although more research is needed to build this evidence base. Published by Elsevier Inc.
PURPOSE:Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, has a rapidly rising prevalence in the United States and a very poor overall rate of survival. This epidemic is driven by the cohort of aging Baby Boomers with hepatitis C viral infection and the increasing prevalence of cirrhosis as a result of nonalcoholic steatohepatitis. Because curative options are limited, the disease course creates, in patients and their families, distressing uncertainty around prognosis and treatment decisions. Older adults are disproportionately affected by HCC and have more comorbidities, adding to the complexity of the disease. This population would benefit from increased access to palliative care services, which can potentially complement the treatments throughout the disease trajectory. The purpose of this review was to use existing evidence to propose a new model of palliative care integration in patients with HCC. Thus, we focus on the HCC stage and the treatment algorithm, the ways that palliative care can offer support in this population at each stage, as well as elements that can enhance patient and family support throughout the entire disease trajectory, with an emphasis on the care of older adults with HCC. METHODS: This is a narrative review in which we identify evidence-based ways that palliative care can help younger and older adults with HCC and their families, at each stage of HCC and throughout the disease trajectory. FINDINGS: We propose ways to integrate HCC and palliative care based on the existing evidence in both fields. Palliative care offers support in symptom management, advanced care planning, and decision making in ways that are specific to each stage of HCC. We also discuss the evidence that illustrates the palliative care needs of patients with HCC that span the entire course of illness, including coping with the stigmatization of liver disease, addressing informational needs at different stages, and discussing quality of life longitudinally. IMPLICATIONS: Integrating palliative care into the treatment of patients with HCC has the potential to improve outcomes, although more research is needed to build this evidence base. Published by Elsevier Inc.
Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Giuseppe Cabibbo; Marcello Maida; Chiara Genco; Pietro Parisi; Marco Peralta; Michela Antonucci; Giuseppe Brancatelli; Calogero Cammà; Antonio Craxì; Vito Di Marco Journal: World J Hepatol Date: 2012-09-27
Authors: Feng Su; Lei Yu; Kristin Berry; Iris W Liou; Charles S Landis; Stephen C Rayhill; Jorge D Reyes; George N Ioannou Journal: Gastroenterology Date: 2015-10-30 Impact factor: 22.682
Authors: Lissi Hansen; Nathan F Dieckmann; Kenneth J Kolbeck; Willscott E Naugler; Michael F Chang Journal: Oncol Nurs Forum Date: 2017-11-01 Impact factor: 2.172
Authors: Josep M Llovet; Sergio Ricci; Vincenzo Mazzaferro; Philip Hilgard; Edward Gane; Jean-Frédéric Blanc; Andre Cosme de Oliveira; Armando Santoro; Jean-Luc Raoul; Alejandro Forner; Myron Schwartz; Camillo Porta; Stefan Zeuzem; Luigi Bolondi; Tim F Greten; Peter R Galle; Jean-François Seitz; Ivan Borbath; Dieter Häussinger; Tom Giannaris; Minghua Shan; Marius Moscovici; Dimitris Voliotis; Jordi Bruix Journal: N Engl J Med Date: 2008-07-24 Impact factor: 91.245
Authors: Arpan A Patel; Anne M Walling; Joni Ricks-Oddie; Folasade P May; Sammy Saab; Neil Wenger Journal: Clin Gastroenterol Hepatol Date: 2017-02-04 Impact factor: 13.576
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485
Authors: Victor de Avila; James M Paik; Leyla de Avila; Linda Henry; Denise Mohess; Alva Roche-Green; Zobair M Younossi Journal: JHEP Rep Date: 2021-01-27
Authors: Manisha Verma; James M Paik; Issah Younossi; Daisong Tan; Hala Abdelaal; Zobair M Younossi Journal: Cancer Med Date: 2021-08-18 Impact factor: 4.452
Authors: Tim F Greten; Ghassan K Abou-Alfa; Ann-Lii Cheng; Austin G Duffy; Anthony B El-Khoueiry; Richard S Finn; Peter R Galle; Lipika Goyal; Aiwu Ruth He; Ahmed O Kaseb; Robin Kate Kelley; Riccardo Lencioni; Amaia Lujambio; Donna Mabry Hrones; David J Pinato; Bruno Sangro; Roberto I Troisi; Andrea Wilson Woods; Thomas Yau; Andrew X Zhu; Ignacio Melero Journal: J Immunother Cancer Date: 2021-09 Impact factor: 13.751