Review Article
Role of Supportive Care for Terminal Stage Hepatocellular Carcinoma

https://doi.org/10.1016/j.jceh.2014.03.049Get rights and content

Patients with end stage or terminal HCC are those presenting with tumors leading to a very poor Performance Status (ECOG 3–4) or Child–Pugh C patients with tumors beyond the transplantation threshold. Among HCC patients, 15–20% present with end stage or terminal stage HCC. Their median survival is less than 3–4 months. The management of end stage or terminal HCC is only symptomatic and no definitive tumor directed treatment is indicated. Patients with end stage or terminal HCC should receive palliative support including management of pain, nutrition and psychological support. In general, they should not be considered for participating in clinical trials. This review focuses on palliative care of terminal stage HCC.

Section snippets

Definition of terminal Hepatocellular Carcinoma

Patients with end stage or terminal HCC are those presenting with tumors leading to a very poor Performance Status (ECOG 3–4) or Child–Pugh C patients with tumors beyond the transplantation threshold,12 which correspond to patient with BCLC class D.

Among HCC patients, 15–20% present with end stage or terminal stage HCC.8, 9 Their median survival is less than 3–4 months.8, 13, 14 The pooled estimate of terminal stage HCC 1-year survival rate was 11% (95% CI, 4.7–22; range, 0–57%), in a meta

What is palliative care?

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.16

HCC patients in the terminal stage of disease may present with a variety of symptoms related to decompensated cirrhosis including ascites, variceal

Pain management in terminal stage Hepatocellular Carcinoma

Pain in HCC can be either from disease or treatment, but irrespective of the cause it is very common and significant cause of morbidity. The pain of HCC tends to be most prominent in the right upper quadrant and described as deep, aching, sharp or stabbing. It may be intermittent and often is referred to the shoulder. Abdominal pain may be categorized as parietal (from inflammation of the visceral lining) or visceral (from spasm, contraction or distension of organs). Abdominal pain in HCC is

Role of radiotherapy in terminal stage Hepatocellular Carcinoma

Physicians have long overlooked radiotherapy (RT) for HCC as radiation might induce fatal hepatic toxicity at doses lower than the therapeutic doses.39 However, such limitation has been overcome by recent developments in RT technology involving precise delivery of focused high-dose on partial volume of the liver.40

Patients with HCC in terminal stage need full symptomatic palliation for local disease or distant metastasis. The most frequent sites of metastases from HCC are the lungs and lymph

Nutrition management in terminal stage Hepatocellular Carcinoma

Malnutrition is commonly encountered in patients with liver disease, especially those with end-stage processes. Patients with liver diseases, especially decompensated cirrhosis, commonly have weight loss and muscle wasting. This problem is due to a variety of underlying processes, including poor caloric and other nutrient intake, problems with the assimilation and absorption of ingested nutrients, and abnormalities in metabolism. Nutritional status assessment is important for identifying the

Symptom management in terminal stage Hepatocellular Carcinoma

Symptom management in terminal stage HCC includes management of anorexia, fatigue, ascites, nausea/vomiting, pruritus and constipation.

Psychosocial issues in terminal stage Hepatocellular Carcinoma

Psychosocial and spiritual concerns are nearly universal among patients who are conscious as they near the end of life.

Conflicts of interest

All authors have none to declare.

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