Unique Palliative Care Challenges in a Young Adult With a Rare Malignancy

The incorporation of a palliative evaluation and care plan development for patients with serious illness is becoming a standard of care in modern medicine. For patients with complex challenges, palliative care physicians are well trained to offer specialized treatment plans and interventions to mitigate symptoms. This case presents the challenges of a mixed hepatocellular carcinoma and hepatoblastoma initially diagnosed in a 17-year-old male. Despite attempts at aggressive cancer-directed treatment, disease progression prompted referral for a palliative evaluation at age 20. Challenges unique to this case include malignant gastric outlet obstruction and refractory hypoglycemia. Through fostering a strong relationship with the patient, our team was able to identify his values and facilitate an individualized palliative and hospice care plan, which included endoscopic ultrasound-guided gastrojejunostomy and continuous at-home dextrose infusions. This case highlights the advancements of palliative medicine in the context of procedural and home intervention, enabling the care team to align the patient's values with his end-of-life goals.