TY - JOUR
T1 - Palliative Care for People With Hepatocellular Carcinoma, and Specific Benefits for Older Adults
AU - Woodrell, Christopher D.
AU - Hansen, Lissi
AU - Schiano, Thomas D.
AU - Goldstein, Nathan E.
N1 - Funding Information:
This work was supported by the National Palliative Care Research Center and by the Claude D. Pepper Older Americans Independence Center at the Icahn School of Medicine (National Institute on Aging, 5 P30 AG028741 08, PI Siu). The funding sources do not create any conflicts of interest for the authors. The authors gratefully acknowledge Suzy L. Goldhirsch (The Brookdale Department of Geriatrics and Palliative Medicine) for her help editing the manuscript, and Rachel Pinotti, MLIS, AHIP (Levy Library, Icahn School of Medicine at Mount Sinai) for her help editing the methods section. The manuscript was written by Dr. Woodrell with significant and equal input from the co-authors, Dr. Hansen, Dr. Schiano, and Dr. Goldstein.
Publisher Copyright:
© 2018
PY - 2018/4
Y1 - 2018/4
N2 - 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.
AB - 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.
KW - cirrhosis
KW - geriatric oncology
KW - hepatocellular carcinoma
KW - palliative care
KW - supportive oncology
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U2 - 10.1016/j.clinthera.2018.02.017
DO - 10.1016/j.clinthera.2018.02.017
M3 - Review article
C2 - 29571567
AN - SCOPUS:85044113667
SN - 0149-2918
VL - 40
SP - 512
EP - 525
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 4
ER -