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Multidisciplinary care of hepatocellular carcinoma
J Van Cleave1, P Devine, P Odom-Ball
1Hematology/Oncology Service, Philadelphia Veterans Affairs Medical Center 19104, USA.
Insights
A multidisciplinary team approach effectively managed hepatocellular carcinoma (HCC) patients, focusing on supportive care and quality of life. This model improved patient and family satisfaction in challenging cases.
Area of Science:
- Hepatobiliary cancers
- Oncology
- Palliative care
Background:
- Hepatocellular carcinoma (HCC) is a prevalent global cancer, though less common in North America.
- Risk factors include viral hepatitis (B and C), cirrhosis, and metabolic diseases.
- Effective therapies for HCC remain limited, with surgical resection being optimal for select early-stage cases.
Purpose of the Study:
- To describe the multidisciplinary care approach for hepatocellular carcinoma (HCC) patients.
- To detail the specific model implemented at the Philadelphia Veterans Affairs Medical Center (PVAMC).
Main Methods:
- Retrospective review of 22 HCC patients diagnosed at PVAMC between January 1995 and May 1998.
- Analysis of the composition and function of the multidisciplinary team.
- Description of supportive care interventions for advanced-stage disease.
Main Results:
- Eighteen of 22 patients had advanced HCC with comorbidities, necessitating supportive care.
- The multidisciplinary team included physicians, nurses, pharmacists, social workers, and a chaplain.
- Supportive care focused on symptom management (ascites, pain, encephalopathy) and psychosocial support.
Conclusions:
- A multidisciplinary team approach enhanced care for advanced HCC patients.
- Patients and families reported satisfaction with the supportive care model.
- Further research is recommended to systematically evaluate interventions for improving HCC patient quality of life.
Objectives:
Multidisciplinary care of cancer patients in varied settings is well described in the literature, but there is little specifically describing the multidisciplinary care of the patient with hepatocellular carcinoma (HCC). The purpose of this article is to describe HCC and the multidisciplinary approach at the Philadelphia Veterans Affairs Medical Center (PVAMC).
Materials And Methods:
HCC is one of the most common solid tumors in the world, but it is rare in North America. It is associated with environmental carcinogens identified in animal studies, hepatitis B and C, cirrhosis of any etiology, and various metabolic diseases. No reliable therapy has been established for HCC. Surgical resection is the best treatment, but it is possible only in the patient with adequate hepatic reserve and limited-stage cancer. From January 1995 to May 1998, 22 patients at PVAMC received a diagnosis of primary HCC. One patient was a candidate for surgery, two patients received radiation therapy, and one patient underwent chemoembolization. Eighteen patients presented with an advanced-stage disease and comorbidities.
Results:
Therapy goals in these 18 patients were limited to supportive care and enhancement of quality of life. A multidisciplinary team provided care to this challenging patient population. The multidisciplinary team treating HCC at PVAMC consisted of physicians, nurses, pharmacists, social workers, and a chaplain. Most care occurred in the outpatient setting. Supportive therapy included the controlling of ascites and abdominal discomfort, hepatic encephalopathy, and pruritus. Opioids relieved abdominal pain. Psychiatric support and counseling helped patients and families cope with the poor prognosis.
Conclusions:
A multidisciplinary team approach helped provide care for this challenging population. Through anecdotal reports, patients and family expressed satisfaction with their care. Research is needed to systematically test interventions designed to enhance quality of life in patients with HCC.