Effects of high-quality nursing care on psychological outcomes and quality of life in patients with hepatocellular carcinoma: A protocol of systematic review and meta-analysis.

BACKGROUND: High quality nursing care (HQNC) has been reported to effectively prevent psychological disorders and improve the quality of life (QoL) in patients with hepatocellular carcinoma (HCC) during the treatment. However, the exact effect of HQNC remains controversial. This systematic review will be aimed to assess the effectiveness of HQNC on psychological disorders and QoL in patients with HCC. METHODS: Eligible prospective controlled clinical trials were searched from Google Scholar, Medline, Excerpt Medica Database (Embase), PubMed, Web of Science (WOS), Cochrane Library, China Scientific Journal Database (CSJD), China National Knowledge Infrastructure (CNKI), Chinese BioMedical Database (CBM) and Wanfang Database. Papers in English or Chinese published from January 2000 to July 2020 will be included without any restrictions. The clinical outcomes including psychological outcomes, QoL, and adverse events of HQNC in patients with HCC were systematically evaluated.Study selection and data extraction will be performed independently by two reviewers. Stata 14.0 and Review Manager 5.3 were used for data analysis. Methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool. Subgroup and meta-regression analysis will be carried out depending on the availability of sufficient data. RESULTS: The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION: The results of this study may provide helpful evidence of HQNC on psychological effects and QoL in patients with HCC. INPLASY REGISTRATION NUMBER: INPLASY202070096.

Palliative Care and Hospice Interventions in Decompensated Cirrhosis and Hepatocellular Carcinoma: A Rapid Review of Literature.

BACKGROUND: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. OBJECTIVE: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. METHODS: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes. RESULTS: Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden. CONCLUSION: Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.

Implementation of a Nurse-driven Educational Program Improves Management of Sorafenib's Toxicities in Hepatocellular Carcinoma.

BACKGROUND: Sorafenib is the standard treatment of advanced hepatocellular carcinoma. Because of its unique toxicities, improving patients' tolerance merits close follow-up. Nurses can play a crucial role by leading a patient educational program (EP). OBJECTIVES: The aim of this study was to assess whether adding EP to usual care (UC) improves patient's care. METHODS: Since 2011, oncologists referred patients treated by sorafenib to the EP led by clinical nurses. The EP included a visit before the first administration, weekly telephone calls, and a visit with the nurse before each oncologist consultation. We retrospectively compared patients in the EP with those in UC followed by an oncologist and patients included in a clinical trial. RESULTS: Since 2005, 129 patients were treated with sorafenib for hepatocellular carcinoma: 31 in the EP (24%), 22 in a clinical trial (17%), and 76 with UC (59%). Seventy-one percent of the patients in the EP had toxicities identified during a telephone call, which prompted symptomatic measures in 65% of the patients, leading to treatment modification before the planned on-site visit in 29% of the patients. Educational program patients required fewer dose reductions (39% vs 61% for UC, P = .04), and median time to first dose reduction was shorter with EP than with UC (25 vs 45 days, P = .036). CONCLUSIONS: This study suggests a clinical benefit of EP related to improved toxicity management of sorafenib that resulted in fewer dose reductions. IMPLICATIONS FOR PRACTICE: Patients treated with sorafenib may benefit from an EP. Different types of EP should be compared prospectively, focusing on patients' quality of life.

Living With Hepatocellular Carcinoma Near the End of Life: Family Caregivers' Perspectives.

PURPOSE/OBJECTIVES: To explore family caregivers' perspectives of caring for patients with terminal hepatocellular carcinoma (HCC) as patients approached the end of life.
. RESEARCH APPROACH: Longitudinal, qualitative descriptive design.
. SETTING: Oregon Health and Science University in Portland and Veterans Affairs Portland Health Care System in Oregon.
. PARTICIPANTS: 13 family caregivers with a mean age of 56 years (range = 22-68 years). The majority of family caregivers were female (n = 10) and identified as White (n = 11).
. METHODOLOGIC APPROACH: Interview data were collected from family caregivers once a month for as many as six months, for a total of 39 interviews. Data were analyzed using conventional content analysis.
. FINDINGS: Five core categories and nine subcategories were identified. From the time of the terminal diagnosis to the end of life, family caregivers felt unprepared, uncertain, and in need of information. They struggled with whether symptoms were HCC- or cirrhosis-related.
. INTERPRETATION: Nurses can support family caregivers by eliciting their knowledge and concerns, and attending to symptom presentation and interpretation and to treatment challenges. Understanding challenges caregivers experience is crucial for developing interventions that address their desire for information, support, and help along the HCC disease trajectory.
. IMPLICATIONS FOR NURSING: Nurses play a critical role in preparing caregivers to understand the importance of pain assessment and management and early referral to palliative care.

[Implementation of a nurse-driven educational program improves management of sorafenib's toxicities in hepatocellular carcinoma]. / Les infirmières cliniciennes améliorent la gestion des toxicités des patients traités par sorafénib pour carcinome hépatocellulaire.

BACKGROUND: Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC). Due to its peculiar toxicities, improving patient's tolerance may need close follow-up. Nurses can play a crucial role, by driving a patient education program (EP). We aimed to prove that adding EP to usual care (UC) improves patient's care. METHODS: Since 2011, oncologists referred patients treated by sorafenib to the EP, driven by clinical nurses. It consisted in a visit before first administration, weekly telephone calls and a visit before each oncologist consultation. We retrospectively compared patients followed by the EP to those followed by oncologist in usual care (UC) and patients included in a clinical trial (CT). RESULTS: Since 2005, 129 patients were treated with sorafenib for HCC, 31 (24%) in the EP, 22 (17%) in CT and 76 (59%) with UC. Seventy-one percent of patients in the EP had toxicities identified during a telephone call, which prompted symptomatic measures in 65% of patients, leading to treatment modification before the planned on-site visit in 29% of patients. EP patients required less dose reductions (39% vs. 61% for UC, P=0.04), and median time to first dose reduction was shorter with EP than with UC (25 days vs. 45 days, P=0.036). CONCLUSION: This study suggests a clinical benefit of EP, with a better toxicity's management of sorafenib, leading to less dose reduction. Different types of EP should be compared prospectively, focusing on quality of life.

Diseases of the Liver.

IMPAIRED LIVER function affects every aspect of the body's physiology. Diseases of the liver have more widespread and life-threatening impacts than malfunctioning of any of the body's other conditions. accessory organs. Non-alcoholic fatty Liver disease rates are soaring, concurrent with the obesity epidemic and increasing rates of type 2 diabetes. Alcoholic liver disease and viral hepatitis also contribute to high rates of liver damage in the population, making liver disease one of the commonest causes premature death. Liver transplants, hepatocellular carcinomas, and deaths from Liver disease are increasingly due to preventable or treatable liver conditions. Understanding normal liver function allows nurses to predict the impact of Liver disease on their patients' health and well-being. Knowledge of underlying causes of impaired liver function enhances our ability to support and counsel those who are at risk of, or have been diagnosed with liver disease.

Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

Management of patients with complications of cirrhosis.

Cirrhosis results from repeated hepatocellular injury over time, leading to portal hypertension and the development of ascites, hepatic encephalopathy, and varices. Despite improvements in medical care for patients with cirrhosis, mortality from infection, renal failure, and hepatocellular carcinoma remain high.

Nurses' experiences with catastrophic upper gastrointestinal bleeding in patients with hepatocellular carcinoma: a qualitative study.

PURPOSE: To explore how nurses experienced catastrophic upper gastrointestinal bleeding in hepatocellular carcinoma (HCC) patients. METHODS: A qualitative descriptive method was used. Data were collected by semi- structured interviews. Twenty-one registered nurses who had taken care of HCC patients with catastrophic upper gastrointestinal bleeding were purposely recruited from the Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital located in mainland China. RESULTS: Four themes explicated from the study were: feelings expressed during the process of rescuing the lives of patients, feelings expressed from succeeding or failing to save the lives of patients, feelings expressed from family members response to nurses' actions, the impact of the experience on the personal life, work and philosophy of life of the nurse subjects. CONCLUSIONS: The findings of this study indicate that it is necessary for nursing leaders to take effective measures to improve nurses' nursing skills, to provide more education in care of the dying, to offer nurses services that address their psychosocial health and to provide them with emotional support.

Vía Clínica. Tratamiento Del Hepatocarcinoma / The clinical pathway of treatment of hepatocellular carcinoma

Introducción: la práctica clínica habitual nos muestra la gran variabilidad presente en la atención médica en pacientes con una misma patología. Las vías clínicas son planes asistenciales integrados y sistematizados para determinados procesos. El desarrollo del proceso asistencial del tratamiento del hepatocarcinoma (HCC) se encuentra dentro del marco asistencial de los departamentos del Área de Tumores HPB (Hepatobiliopancreática), Hepatología y Cirugía General de la Clínica Universidad de Navarra (CUN). Objetivos: elaborar una vía clínica capaz de organizar, homogeneizar y estandarizar la atención de los pacientes diagnosticados de HCC y que se pueda aplicar desde el inicio hasta el final en el transcurso de esta enfermedad. Metodología: se ha definido el conjunto de actos asistenciales necesarios para atender de la mejor forma posible a un paciente que acuda a la Clínica para ser tratado de hepatocarcinoma. El ámbito del estudio se encuentra en la CUN, clínica privada que forma parte de la Universidad de Navarra. Resultado: se ha desarrollado la vía clínica del tratamiento del hepatocarcinoma, centrada en el tratamiento quirúrgico y el trasplante hepático. Conclusiones: las vías clínicas suponen una disminución de la variabilidad y un control de calidad en la práctica clínica, permitiendo analizar la información que nos proporcionan los indicadores, las encuestas de satisfacción y el registro informático de los datos(AU)

Introduction: The regular clinical practise slows a wide variability present in medical care in patients with the same pathology. The clinical pathways are integrated and systematized care plans for certain processes. The development of the hepatocarcinoma's (HCC) health care treatment is within the care frame of Tumoral Area's departments, Hepatology and General Surgery in the Clinic University Of Navarra (CUN). Objectives: To conduct a clinical pathway able to organize, homogenize and standardize the care of patients diagnosed with hepatocarcinoma and that could be applied from the beginning to the end of the course of this disease. Methodology: The identification of the set of care procedures wich would be necessary to achieve the best possible result in a patient who comes to the clinic to be treated for an hepatocarcinoma. The study' scope has taken place at the CUN, a private clinic that is a part of the University of Navarra. Result: The clinical pathway of the hepatocarcinoma's treatment has been developed centered on the surgical treatment and the hepatic transplant. Conclusion: The clinical pathways represents a decrease in variability and quality control in clinical practice, and the ability to analyze the information that indicators provide us, the satisfaction surveys and the computerized registration of electronic data(AU)

Interventional radiology in oncology: clinical management of patients undergoing transarterial chemoembolization for hepatic malignancies.

Interventional radiology procedures treat a variety of solid tumor malignancies. Transarterial chemoembolization (TACE) is a minimally invasive procedure performed under fluoroscopic guidance that is used in treatment of hepatic malignancies because of hepatocellular carcinoma or malignancy that has metastasized to the liver. Patients undergoing a TACE procedure may manifest postembolization symptoms such as fever, nausea, vomiting, and abdominal pain, which may persist after discharge. Patients need to be educated on the importance of compliance with prescribed medications, clinical symptoms to be expected, and signs of potential complications that need to be reported.

Late SV40 factor (LSF) enhances angiogenesis by transcriptionally up-regulating matrix metalloproteinase-9 (MMP-9).

The transcription factor late SV40 factor (LSF) is overexpressed in human hepatocellular carcinoma (HCC) fostering a highly aggressive and metastatic phenotype. Angiogenesis is an essential component of cancer aggression and metastasis and HCC is a highly aggressive and angiogenic cancer. In the present studies, we analyzed the molecular mechanism of LSF-induced angiogenesis in HCC. Employing human umbilical vein endothelial cells (HUVEC) differentiation assay and chicken chorioallantoic membrane (CAM) assay we document that stable LSF overexpression augments and stable dominant negative inhibition of LSF (LSFdn) abrogates angiogenesis by human HCC cells. A quest for LSF-regulated factors contributing to angiogenesis, by chromatin immunoprecipitation-on-chip (ChIP-on-chip) assay, identified matrix metalloproteinase-9 (MMP-9) as a direct target of LSF. MMP-9 expression and enzymatic activity were higher in LSF-overexpressing cells and lower in LSFdn-expressing cells. Deletion mutation analysis identified the LSF-responsive regions in the MMP-9 promoter and ChIP assay confirmed LSF binding to the MMP-9 promoter. Inhibition of MMP-9 significantly abrogated LSF-induced angiogenesis as well as in vivo tumorigenesis, thus reinforcing the role of MMP-9 in facilitating LSF function. The present findings identify a novel target of LSF contributing to its oncogenic properties.

Periprocedural pain of radiofrequency ablation for hepatocellular carcinoma.

Although radiofrequency ablation has been accepted as a safe and effective treatment for small hepatocellular carcinoma, there are few studies addressing periprocedural pain. Our study aims were to investigate periprocedural pain and evaluate its related factors. Ninety-nine patients diagnosed as having hepatocellular carcinoma and who underwent radiofrequency ablation were consecutively enrolled. The pain intensity, mental preparation status for radiofrequency ablation, and demographic and clinical characteristics were investigated. We used an 11-point numerical rating scale to assess for pain. Forty-three percent of subjects reported the intensity of periprocedural pain as more than a level of six (severe pain). The longer duration of ablation (r(s) = .29, p = .004), the number of ablations (r(s) = .27, p = .008), higher pain anxiety (r(s) = .42, p < .001), and difficulty sleeping on the previous day (r(s) = .24, p = .019) were factors related to experiencing more severe pain. The major related factors to severe periprocedural pain were the longer duration of ablation and the more anxiety about pain. Clinicians should offer better information to radiofrequency ablation patients regarding pain expectations and carefully consider periprocedural analgesia requirements.

Managing patients receiving sorafenib for advanced hepatocellular carcinoma: a case study.

Despite improvements in cytotoxic chemotherapy agents over the last 50 years, the outlook for patients with many of the most common solid tumours has remained poor. However, in recent years a number of targeted therapies have been licensed in the European Union for use in these cancer types. One such therapy, a tyrosine kinase inhibitor (sorafenib) is now used to treat patients with advanced hepatocellular carcinoma (HCC) and metastatic renal cell carcinoma. This article will explore the role of the oncology nurse in managing patients receiving sorafenib for advanced HCC. A brief overview of sorafenib as a current treatment approved for advanced HCC in the palliative setting is presented. This is followed by a case study-based discussion with particular reference to some of the key care coordination challenges facing the oncology nurse. The management of treatment-related adverse events and the importance of using a multidisciplinary team approach is also reviewed.

Symptom management in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) annually causes about one million deaths. Because of advanced stage at diagnosis, HCC carries a five-year survival rate of less than 5% in patients diagnosed with unresectable disease. Incidence for HCC is higher in men and individuals of Asian descent, where viral hepatitis, a leading cause of HCC, is endemic. This article will provide an overview of the complex symptom management of patients with HCC. The occurrence of multiple symptoms, including pain, fatigue, weight loss, and obstructive syndromes (e.g., ascites, jaundice) in patients with HCC is common. Because of limitations in the efficacy of current treatment options, aggressive symptom management is key to preserving physical functioning and quality of life in patients with HCC. A multidisciplinary team approach to symptom management of patients with HCC is critical, with oncology nurses playing an integral role.

Management of patients who have undergone hepatic artery chemoembolization.

Hepatocellular carcinoma (HCC) is the fifth most common cause of all malignancies and causes approximately one million deaths each year. Surgical liver resection is the only cure for HCC; however, few patients are eligible to undergo this procedure. Hepatic artery chemoembolization (HACE) is a technique that delivers high concentrations of chemotherapeutic agents and blocks the blood supply to the liver for prolonged periods of time. HACE has demonstrated an overall increase in survival. The HACE procedure, pre- and postprocedure complications, and the care required by patients with HCC are critical for oncology nurses to understand.

Hospice palliative care for patients with hepatocellular carcinoma in Taiwan.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in Taiwan. In order to delineate the unique demographic features and clinical profile of terminal HCC, we conducted a retrospective study in a hospital-based hospice in Taiwan. Of a total of 991 terminally ill cancer patients (654 men and 337 women, mean age 66.1 years) admitted to our palliative care unit during a three-year period, 110 patients (11.1%) were diagnosed as having HCC (93 men and 17 women, mean age 60.5 years). The most common metastatic sites were bone and lung. Eighty-five HCC patients (77.3%) also had associated liver cirrhosis. The most common symptoms of HCC patients upon admission to the hospice ward were pain, fatigue or weakness, anorexia/vomiting, peripheral edema, cachexia, and ascites. Hypoalbuminemia, anemia, hyponatremia and jaundice were common laboratory abnormalities. Eighty-four patients (76.4%) required opiates for pain management. Upper gastrointestinal bleeding or varices bleeding developed in 76 patients (69.1%). Ninety-four patients (85.5%) died at the hospital, and the overall median survival time at hospice ward was 12 days. Because of more severe underlying portal hypertension and deteriorated liver function, terminal HCC patients with decompensated liver cirrhosis (Child-Pugh class C) had a significantly higher prevalence of peripheral edema, ascites, dyspnea, jaundice, thrombocytopenia, and stage III-IV hepatic encephalopathy than noncirrhotic or Child-Pugh class A and B terminal HCC patients. Symptoms and signs resulting from these portal hypertensions frequently complicated the symptomatic management of terminal HCC patients in the hospice ward. The treatment of these complications is mostly empirical in hospice ward, where intensive laboratory or diagnostic tests are usually not performed. In conclusion, symptoms and signs of terminally ill HCC patients in hospice are unique and should be managed appropriately.

What's old is new again: patients receiving hepatic arterial infusion chemotherapy.

Hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. Although uncommon in North America, the incidence of HCC in the United States has increased by 70% since the 1980s (Yu, Yuan, Govindarajan, & Ross, 2000). The most frequent causes of malignant hepatic disease in the United States are metastases from melanoma and primary tumors of the gastrointestinal tract, breast, and lung. Surgical resection and systemic chemotherapy are the standard treatments for this disease. However, surgery is not an option for patients with advanced disease, and the response rate from systemic chemotherapy remains low. An alternative therapy for patients with HCC or cancers with liver metastases is hepatic arterial infusion of chemotherapy directly into the liver. This method allows a high total body clearance and hepatic extraction to generate high hepatic and low systemic exposures. Nursing care of patients receiving hepatic arterial infusion of chemotherapy includes patient education and monitoring for complications.