• Massimo Iavarone, Lorenzo Canova, Eleonora Alimenti, Alessio Aghemo, Diego Taveggia, Gino Gobber, Giuseppe Cabibbo, Simone Veronese, Vincenza Calvaruso, Luciano Orsi, Paolo Caraceni, Pietro Lampertico, and Italian Association for the Study of the Liver (AISF) and Italian Society of Palliative Care (SICP).
• Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
• Palliat Med. 2024 Oct 1; 38 (9): 103310411033-1041.

BackgroundDelays and limitations of palliative care in patients with liver transplantation-ineligible end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.AimTo assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.DesignMembers of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-ineligible end-stage hepatocellular carcinoma.ParticipantsPhysician members of the of the two associations, representing several hospitals and services in the country.ResultsNinety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1-19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function.ConclusionsThis survey highlights significant differences in the approach to patients with liver transplantation-ineligible end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.

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