Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis

Peng, Jen‐Kuei; Hepgul, Nilay; Higginson, Irene J; Gao, Wei

doi:10.1177/0269216318807051

Cited by 202 publications

(205 citation statements)

References 121 publications

(228 reference statements)

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“…The physical and psychological symptom burden and social‐role consequences of ESLD are often worse than those for many non‐liver cancers. ( 4 ) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. ( 4 ) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer.…”

Section: Organization Definitionmentioning

confidence: 99%

“…( 4 ) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. ( 4 ) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer. ( 5 ) However, interventions to improve the quality of life (QOL) for patients with ESLD and their caregivers are underdeveloped.…”

Section: Organization Definitionmentioning

confidence: 99%

“…( 24 ) Fear of upsetting patients, not wanting to abandon them, considering PC referral as an admission of failure/no hope, patients’ having impaired cognitive capacity to participate in provider‐led discussions, and providers not completely understanding the benefits of PC are other reasons. ( 4 ) For health systems, implementation and policy barriers have been identified. ( 25 ) Implementation barriers include limited number of providers with PC training, challenges in identifying patients for appropriate PC referral at the systems level, and need for a culture change across settings.…”

Section: Barriers To Implementing Pcmentioning

confidence: 99%

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Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

2020

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Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically. (Hepatology 2020;71:2149-2159). E nd-stage liver disease (ESLD) is the 12th leading cause of death and claims approximately 66,000 lives each year in the United States. (1) Between 2006 and 2016, the prevalence of ESLD increased by 7.9% among men 25-34 years of age and 11.4% among women in the same age group because of the increasing burden of nonalcoholic steatohepatitis, alcohol-associated liver disease, and advanced hepatitis C virus. (2) In parallel, mortality due to ESLD increased by 65% from 1999 to 2016. (3) ESLD is also associated with functional and cognitive impairment, often with concomitant mental health and substance use disorders. The physical and psychological symptom burden and social-role consequences of ESLD are often worse than those for many non-liver cancers. (4) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. (4) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer. (5) However, interventions to improve the quality of life (QOL) for patients with ESLD and their caregivers are underdeveloped.Palliativ...

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Section: Organization Definitionmentioning

confidence: 99%

Section: Organization Definitionmentioning

confidence: 99%

Section: Barriers To Implementing Pcmentioning

confidence: 99%

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Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

2020

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“…Peng et al's systematic review and meta-analysis in 2019 assessed symptom prevalence and health-related quality of life for patients with end-stage liver disease. 9 It included 80 studies from Europe, North America, Asia, and Africa and found significant physical problems including pain (30-79% patients), breathlessness (20-88%), muscle cramps (56-68%), erectile dysfunction (53-93%), sleep disturbance (26-77%), fatigue (52-86%), and pruritus (47-64%). Psychological burden was also prevalent including anxiety (14-45%) and depression (4.5-64%).…”

Section: The Tremendous Symptom Burden Of Advanced Liver Diseasementioning

confidence: 99%

“…In addition to their substantial mortality burden, it is often underappreciated that patients with advanced liver disease live with a symptom burden paralleling that of patients with advanced malignancy. 9 In an effort to improve care, the last decade has seen a surge in the number of publications addressing the palliative care needs of patients with advanced liver disease. Unlike common misperceptions, 10 palliative care is a broad umbrella term that subsumes end-of-life care.…”

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confidence: 99%

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Jordan

Tandon

2019

Semin Liver Dis

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Advanced liver disease is increasing in mortality and morbidity worldwide, as a result of growing alcohol consumption, obesity, and viral hepatitis infection. Alongside efforts to reduce these factors, it is clear that we must identify the considerable palliative care needs of these patients in order to improve quality of life and reduce symptom burden. Our review focuses on the current state of palliative and end-of-life care for patients with advanced liver disease, the significant associated symptom burden in this disease group, identified level of involvement and potential benefits of specialist palliative care, as well as possible barriers to accessing this care. We demonstrate that although palliative care involvement varies considerably worldwide, there is much opportunity for improvement. Further research is needed to determine new interventions and models of care that may improve access for patients with liver disease, including an expansion of providers comfortable with generalist palliative care.

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Diagnosis and Management of Cirrhosis and Its Complications

Tapper

Parikh

2023

JAMA

104

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ImportanceCirrhosis affects approximately 2.2 million adults in the US. From 2010 to 2021, the annual age-adjusted mortality of cirrhosis increased from 14.9 per 100 000 to 21.9 per 100 000 people.ObservationsThe most common causes of cirrhosis in the US, which can overlap, include alcohol use disorder (approximately 45% of all cases of cirrhosis), nonalcoholic fatty liver disease (26%), and hepatitis C (41%). Patients with cirrhosis experience symptoms including muscle cramps (approximately 64% prevalence), pruritus (39%), poor-quality sleep (63%), and sexual dysfunction (53%). Cirrhosis can be diagnosed by liver biopsy but may also be diagnosed noninvasively. Elastography, a noninvasive assessment of liver stiffness measured in kilopascals, can typically confirm cirrhosis at levels of 15 kPa or greater. Approximately 40% of people with cirrhosis are diagnosed when they present with complications such as hepatic encephalopathy or ascites. The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively. Among people with ascites, the annual incidence of spontaneous bacterial peritonitis is 11% and of hepatorenal syndrome is 8%; the latter is associated with a median survival of less than 2 weeks. Approximately 1% to 4% of patients with cirrhosis develop hepatocellular carcinoma each year, which is associated with a 5-year survival of approximately 20%. In a 3-year randomized clinical trial of 201 patients with portal hypertension, nonselective β-blockers (carvedilol or propranolol) reduced the risk of decompensation or death compared with placebo (16% vs 27%). Compared with sequential initiation, combination aldosterone antagonist and loop diuretics were more likely to resolve ascites (76% vs 56%) with lower rates of hyperkalemia (4% vs 18%). In meta-analyses of randomized trials, lactulose was associated with reduced mortality relative to placebo (8.5% vs 14%) in randomized trials involving 705 patients and reduced risk of recurrent overt hepatic encephalopathy (25.5% vs 46.8%) in randomized trials involving 1415 patients. In a randomized clinical trial of 300 patients, terlipressin improved the rate of reversal of hepatorenal syndrome from 39% to 18%. Trials addressing symptoms of cirrhosis have demonstrated efficacy for hydroxyzine in improving sleep dysfunction, pickle brine and taurine for reducing muscle cramps, and tadalafil for improving sexual dysfunction in men.Conclusions and RelevanceApproximately 2.2 million US adults have cirrhosis. Many symptoms, such as muscle cramps, poor-quality sleep, pruritus, and sexual dysfunction, are common and treatable. First-line therapies include carvedilol or propranolol to prevent variceal bleeding, lactulose for hepatic encephalopathy, combination aldosterone antagonists and loop diuretics for ascites, and terlipressin for hepatorenal syndrome.

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Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis

Cited by 202 publications

References 121 publications

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Diagnosis and Management of Cirrhosis and Its Complications

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