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Abasseri M, Hoque S, Caldwell K, Sheahan L, Kochovska S, Agar M, Zekry A. Exploring Misconceptions of Palliative Care Among Patients With Hepatocellular Carcinoma: A Pilot Study. Am J Hosp Palliat Care 2024:10499091241268423. [PMID: 39157978 DOI: 10.1177/10499091241268423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma is a burdensome form of liver cancer with an increasing global prevalence. Emerging evidence has shown that early palliative care introduction at diagnosis of any life-limiting illness improves patient and carer outcomes. Despite this, patients with hepatocellular carcinoma usually receive palliative care late. These patients are important stakeholders in the provision of palliative care, but their perceived barriers regarding its delivery are poorly defined. AIM This pilot study aimed to identify the barriers perceived by patients to integrating palliative care into the hepatocellular carcinoma treatment algorithm. DESIGN Patients living with hepatocellular carcinoma undertook semi-structured interviews about their perceptions of palliative care. We compared these perceptions before and after providing a brief explanation of palliative care. Interview data was inductively coded in NVivo 12 (2018) and thematically analysed. RESULTS Twenty-one patients were interviewed. 16 perceived palliative care to mean end-of-life therapy, and nine participants had no prior knowledge of palliative care. After hearing a definition of palliative care, 17 participants reported changed positive attitudes. Seven participants supported a name change, including four participants who continued to reject palliative care following the explanation due to the negative stigma associated with the term 'palliative care'. CONCLUSION There is significant misperception about the purpose of palliative care among patients with hepatocellular carcinoma, constituting a barrier to early integration. This can be feasibly addressed with a two-folded educational and renaming initiative to dispel patient misconceptions regarding palliative care. Effective strategies to achieve this should be developed and tested with relevant stakeholders, particularly patients.
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Affiliation(s)
| | - Shakira Hoque
- Gastroenterology and Hepatology Department, St George Hospital, Sydney, NSW, Australia
| | - Kim Caldwell
- Palliative Medicine, Calvary Hospital Kogarah, Kogarah, NSW, Australia
- Palliative Medicine Department, St George Hospital, Sydney, NSW, Australia
| | - Linda Sheahan
- Clinical Ethics Service, South Eastern Sydney Local Health District, Randwick, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Camperdown, NSW, Australia
- St George and Sutherland Clinical Campus, UNSW Medicine & Health, Sydney, NSW, Australia
- Palliative Medicine Department, St George Hospital, Sydney, NSW, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- IMPACCT, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Amany Zekry
- School of Medicine and Health, UNSW, Sydney, NSW, Australia
- Gastroenterology and Hepatology Department, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical Campus, UNSW Medicine & Health, Sydney, NSW, Australia
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2
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Aldecoa KAT, Macaraeg CSL, Abougergi MS, Krishnamoorthy G, Arsene C. Palliative Care Utilization Among Hospitalized Patients With Hepatocellular Cancer: A Nationwide Study in the Pandemic Era (2019-2021). Am J Hosp Palliat Care 2024:10499091241271371. [PMID: 39138972 DOI: 10.1177/10499091241271371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
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Affiliation(s)
- Kim Abbegail Tan Aldecoa
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | | | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Medical Campus, Great Falls, VA
- Catalyst Medical Consulting, Huntington Valley, PA, USA
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Camelia Arsene
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
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3
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Wu G, Li F, Guo D, Xi K, Zheng D, Huang R, Wu X, Li A, Liu X. Comprehensive evaluation of genes related to basement membrane in hepatocellular carcinoma. Aging (Albany NY) 2024; 16:10108-10131. [PMID: 38870261 PMCID: PMC11210257 DOI: 10.18632/aging.205923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/03/2024] [Indexed: 06/15/2024]
Abstract
In all mammals, the basement membrane serves as a pivotal extracellular matrix. Hepatocellular carcinoma (HCC) is a challenge among numerous cancer types shaped by basement membrane-related genes (BMGs). Our research established an innovative prognostic model that is highly accurate in its prediction of HCC prognoses and immunotherapy efficacy to summarize the crucial role of BMGs in HCC. We obtained HCC transcriptome analysis data and corresponding clinical data from The Cancer Genome Atlas (TCGA). To augment our dataset, we incorporated 222 differentially expressed BMGs identified from relevant literature. A weighted gene coexpression network analysis (WGCNA) of 10158 genes demonstrated four modules that were connected to HCC. Additionally, 66 genes that are found at the intersection of BMGs and HCC-related genes were designated as hub HCC-related BMGs. MMP1, ITGA2, P3H1, and CTSA comprise the novel model that was engineered using univariate and multivariate Cox regression analysis. Furthermore, the International Cancer Genome Consortium (ICGC) and Gene Expression Omnibus (GEO) datasets encouraged the BMs model's validity. The overall survival (OS) of individuals with HCC may be precisely predicted in the TCGA and ICGC databases utilizing the BMs model. A nomogram based on the model was created in the TCGA database at similar time, and displayed a favorable discriminating ability for HCC. Particularly, when compared to the patients at an elevated risk, the patients with a low-risk profile presented different tumor microenvironment (TME) and hallmark pathways. Moreover, we discovered that a lower risk score of HCC patients would display a greater response to immunotherapy. Finally, quantitative real-time PCR (qRT-PCR) experiments were used to verify the expression patterns of BMs model. In summary, BMs model demonstrated efficacy in prognosticating the survival probability of HCC patients and their immunotherapeutic responsiveness.
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Affiliation(s)
- Guojing Wu
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Fei Li
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Danyan Guo
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Kaiwen Xi
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Dayong Zheng
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Ruichao Huang
- Heshan Hospital of Traditional Chinese Medicine, Jiangmen 529000, China
| | - Xiuqiong Wu
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Aimin Li
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
| | - Xinhui Liu
- Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou 510315, China
- Cancer Center, Southern Medical University, Guangzhou 510315, China
- Heshan Hospital of Traditional Chinese Medicine, Jiangmen 529000, China
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4
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Ma X, Bai M. Effect of Family Music Therapy on Patients with Primary Liver Cancer Undergoing Palliative Care and their Caregivers: A Retrospective Study. Noise Health 2024; 26:120-127. [PMID: 38904811 DOI: 10.4103/nah.nah_17_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/25/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE The effectiveness of family music therapy for patients with advanced palliative care hepatocellular carcinoma and their main caregivers was investigated. METHODS The clinical data of liver cancer patients and their main caregivers admitted to Wuwei City People's Hospital from August 2022 to April 2023 were retrospectively analysed. Patients were divided into observation group A and control group A according to whether they received family music therapy, and caregivers were divided into control group B and observation group B. The general demographic data, self-rating depression scale (SDS), self-rating anxiety scale (SAS), cancer-related fatigue scale (CFS), Pittsburgh sleep quality index (PSQI), anticipatory grief scale (AGS), and caregiver burden inventory (CBI) scores of the patients and their primary caregivers were collected. Propensity score matching (PSM) was used to balance the baseline data of the two groups. Then, data were analysed using t-test and chi-squared (χ2) test. RESULTS After 1:1 PSM, 45 samples were included in each group. Before management, no significant differences in SDS, SAS, AGS, CFS, PSQI and CBI scores were found among the groups (P > 0.05). After management, the SDS, SAS and CFS scores of observation group A were lower than those of control group A (P < 0.05). The AGS, PSQI and CBI scores of observation group B were lower than those of control group B (P < 0.05). CONCLUSIONS The effect of family music supplement therapy is ideal, which can relieve the negative emotions of patients, reduce the degree of cancer-related fatigue, enhance the sleep quality of the main caregivers and reduce anticipatory grief and the burden of care.
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Affiliation(s)
- Xiaoyun Ma
- Department of Digestive, Wuwei City People's Hospital, Wuwei City, Gansu Province, China
| | - Manling Bai
- Department of Infections, Wuwei City People's Hospital, Wuwei City, Gansu Province, China
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Management of Hepatocellular Carcinoma in Decompensated Cirrhotic Patients: A Comprehensive Overview. Cancers (Basel) 2023; 15:cancers15041310. [PMID: 36831651 PMCID: PMC9954723 DOI: 10.3390/cancers15041310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Primary liver cancer is the sixth most common cancer and the fourth leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for 75% of primary liver cancer cases, mostly on the basis of cirrhosis. However, the data and therapeutic options for the treatment of HCC in patients with decompensated cirrhosis are rather limited. This patient category is often considered to be in a terminal stage without the possibility of a specific treatment except liver transplantation, which is restricted by several criteria and liver donor shortages. Systemic treatments may provide a solution for patients with Child Pugh class B or C since they are less invasive. Although most of the existing trials have excluded patients with decompensated cirrhosis, there are increasing data from real-life settings that show acceptable tolerability and satisfying efficacy in terms of response. The data on the administration of locoregional treatments in such patients are also limited, but the overall survival seems to be potentially prolonged when patients are carefully selected, and close adverse event monitoring is applied. The aim of this review is to analyze the existing data regarding the administration of treatments in decompensated patients with HCC, evaluate the effect of therapy on overall survival and highlight the potential risks in terms of tolerability.
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6
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Klankaew S, Temthup S, Nilmanat K, Fitch MI. The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma. Healthcare (Basel) 2023; 11:healthcare11040460. [PMID: 36832996 PMCID: PMC9956382 DOI: 10.3390/healthcare11040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre-post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher's exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization.
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Affiliation(s)
- Sukhuma Klankaew
- Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Suthisa Temthup
- Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Correspondence:
| | - Kittikorn Nilmanat
- Faculty of Nursing, Prince of Songkla University, Songkhla 90110, Thailand
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M4C 4V9, Canada
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7
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Abasseri M, Hoque S, Slavica Kochovska BA, Caldwell K, Sheahan L, Zekry A. Barriers to palliative care in hepatocellular carcinoma: A review of the literature. J Gastroenterol Hepatol 2023. [PMID: 36634200 DOI: 10.1111/jgh.16107] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
Hepatocellular carcinoma (HCC) is a deadly and burdensome form of liver cancer with an increasing global prevalence. Its course is unpredictable as it frequently occurs in the context of underlying end-stage liver disease, and the associated symptoms and adverse effects of treatment cause severe suffering for patients. Palliative care (PC) is a medical specialty that addresses the physical, emotional, and spiritual needs of patients and their carers in the context of life-limiting illness. In other cancers, a growing body of evidence has demonstrated that the early introduction of PC at diagnosis improves patient and carer outcomes. Despite this, the integration of palliative care at the diagnosis of HCC remains suboptimal, as patients usually receive PC only at the very terminal phase of their disease, even when diagnosed early. Significant barriers to the uptake of palliative care in the treatment algorithm of hepatocellular carcinoma fall under four main themes: data limitations, disease, clinician, and patient factors. Barriers relating to data limitations mainly encapsulated the risk of bias inherent in published work in the field of PC. Clinician-reported barriers related to negative attitudes towards PC and a lack of time for PC discussions. Barriers related to the disease align with prognostic uncertainty due to the unpredictable course of HCC. Significantly, there exists a paucity of evidence exploring patient-perceived barriers to timely PC implementation in HCC. Given that patients are often the underrepresented stakeholder in the delivery of PC, future research should explore the patient perspective in adequately designed qualitative studies as the first step.
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Affiliation(s)
- Mostafa Abasseri
- School of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | - Shakira Hoque
- Gastroenterology and Hepatology Department, St George Hospital, Sydney, New South Wales, Australia
| | - B A Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,IMPACCT, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Kim Caldwell
- Palliative Medicine, Calvary Hospital Kogarah, Kogarah, New South Wales, Australia
| | - Linda Sheahan
- Clinical Ethics Service, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.,Sydney Health Ethics, The University of Sydney, Camperdown, New South Wales, Australia.,UNSW Medicine & Health, St George and Sutherland Clinical Campus.,Palliative Medicine Department, St George Hospital, Sydney, New South Wales, Australia
| | - Amany Zekry
- School of Medicine and Health, UNSW, Sydney, New South Wales, Australia.,Gastroenterology and Hepatology Department, St George Hospital, Sydney, New South Wales, Australia.,UNSW Medicine & Health, St George and Sutherland Clinical Campus
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8
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Mouhoubi N, Bamba-Funck J, Sutton A, Blaise L, Seror O, Ganne-Carrié N, Ziol M, N’Kontchou G, Charnaux N, Nahon P, Nault JC, Guyot E. Sulfatase 2 Along with Syndecan 1 and Glypican 3 Serum Levels are Associated with a Prognostic Value in Patients with Alcoholic Cirrhosis-Related Advanced Hepatocellular Carcinoma. J Hepatocell Carcinoma 2022; 9:1369-1383. [PMID: 36597436 PMCID: PMC9805748 DOI: 10.2147/jhc.s382226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/07/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Sulfatase 2 (SULF2) is an enzyme related to heparan sulfate modifications. Its expression, as for some heparan sulfate proteoglycans expression, has been linked to hepatocellular carcinoma (HCC) at mRNA level and immunohistochemistry staining on biopsy samples. This study aims to evaluate the prognostic value of serum levels of SULF2 in patients with alcoholic cirrhosis with or without HCC. Patients and Methods Two hundred and eighty-seven patients with alcoholic cirrhosis were enrolled in this study: 164 without HCC, 57 with early HCC, and 66 with advanced HCC at inclusion. We analyzed the association between SULF2 serum levels and prognosis using Kaplan-Meier method and univariate and multivariate analysis using a Cox model. Results Child-Pugh C Patients have higher serum levels of SULF2 than Child-Pugh A patients. Serum levels of SULF2 were also higher in patients with advanced HCC compared with the other groups. In patients with advanced HCC, high serum levels of SULF2 were associated with less favorable overall survival. Combination of SULF2 with Glypican 3 (GPC3) and Syndecan 1 (SDC1) serum levels enhanced the ability to discriminate worst prognostic in advanced HCC. Conclusion SULF2 along with GPC3 and SDC1 serum levels have been shown to be associated with a prognostic value in advanced HCC.
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Affiliation(s)
- Nesrine Mouhoubi
- Université Sorbonne Paris Nord, Laboratory for VascularTranslational Science, LVTS, INSERM, UMR 1148, Bobigny, F- 93000, France
| | - Jessica Bamba-Funck
- Université Sorbonne Paris Nord, Laboratory for VascularTranslational Science, LVTS, INSERM, UMR 1148, Bobigny, F- 93000, France,Service de biochimie, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France
| | - Angela Sutton
- Université Sorbonne Paris Nord, Laboratory for VascularTranslational Science, LVTS, INSERM, UMR 1148, Bobigny, F- 93000, France,Service de biochimie, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France
| | - Lorraine Blaise
- Service d’hépatologie, Hôpital Avicenne, AP-HP, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, F-93143, France
| | - Olivier Seror
- Service de radiologie, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France
| | - Nathalie Ganne-Carrié
- Service d’hépatologie, Hôpital Avicenne, AP-HP, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, F-93143, France,Inserm, UMR 1162, Génomique fonctionnelle des tumeUrs solides, Paris, F-75010, France
| | - Marianne Ziol
- Centre de Ressources Biologiques BB-0033-00027, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France,Service d’anatomie et cytologie pathologique, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France
| | - Gisèle N’Kontchou
- Service d’hépatologie, Hôpital Avicenne, AP-HP, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, F-93143, France
| | - Nathalie Charnaux
- Université Sorbonne Paris Nord, Laboratory for VascularTranslational Science, LVTS, INSERM, UMR 1148, Bobigny, F- 93000, France,Service de biochimie, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France
| | - Pierre Nahon
- Service d’hépatologie, Hôpital Avicenne, AP-HP, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, F-93143, France,Inserm, UMR 1162, Génomique fonctionnelle des tumeUrs solides, Paris, F-75010, France
| | - Jean-Charles Nault
- Service d’hépatologie, Hôpital Avicenne, AP-HP, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, F-93143, France,Inserm, UMR 1162, Génomique fonctionnelle des tumeUrs solides, Paris, F-75010, France
| | - Erwan Guyot
- Université Sorbonne Paris Nord, Laboratory for VascularTranslational Science, LVTS, INSERM, UMR 1148, Bobigny, F- 93000, France,Service de biochimie, Hôpital Avicenne, hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, F-93000, France,Correspondence: Erwan Guyot, Hôpitaux Universitaires Paris Seine-Saint-Denis, Laboratoire Biochimie-Pharmacologie et Biologie Moléculaire, 125 Rue de Stalingrad, Bobigny, 93000, France, Tel +33 1 48 95 56 29, Fax +33 1 48 95 56 27, Email
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9
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Billiot AA, Danos DM, Stevens J, Vance KM, Raven MC, Lyons JM. Palliative care reduces emergency room visits and total hospital days among patients with metastatic HPB and GI cancers. Sci Rep 2022; 12:21068. [PMID: 36473913 PMCID: PMC9727158 DOI: 10.1038/s41598-022-23928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Palliative care services (PCS) have improved quality of life for patients across various cancer subtypes. Minimal data exists regarding PCSfor metastatic hepatopancreaticobiliary (HPB) and gastrointestinal (GI) cancers. We assessed the impact of PCS on emergency department visits, hospital admissions, and survival among these patients. Patients with metastatic HPB and GI cancer referred to outpatient PCS between 2014 and 2018 at a single institution were included. We compared the demographics, outcomes, and end-of-life indicators between those who did and did not receive PCS. The study included 183 patients, with 118 (64.5%) having received PCS. There were no significant differences in age, gender, race, marital status, or insurance. Those receiving PCS were more likely to have colorectal cancer (p = 0.0082) and receive chemotherapy (p = 0.0098). On multivariate analysis, PCS was associated with fewer ED visits (p = 0.0319), hospital admissions (p = 0.0002), and total inpatient hospital days (p < 0.0001) per 30 days of life. Overall survival was greater among patients receiving PCS (HR: 0.65 (0.46-0.92)). Outpatient PCS for patients with metastatic HPB and GI cancer is associated with fewer emergency department visits, hospital admissions, and inpatient hospital days, and improved overall survival.
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Affiliation(s)
- Angelle A. Billiot
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA
| | - Denise M. Danos
- grid.279863.10000 0000 8954 1233LSUHSC School of Public Health, New Orleans, LA USA
| | - Jenny Stevens
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA
| | - Katie M. Vance
- Our Lady of the Lake-Division of Academic Affairs, Baton Rouge, LA USA
| | - Mary C. Raven
- Our Lady of the Lake Cancer Institute, 7777 Hennessy Blvd, Baton Rouge, LA 70808 USA
| | - John M. Lyons
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA ,Our Lady of the Lake Cancer Institute, 7777 Hennessy Blvd, Baton Rouge, LA 70808 USA
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10
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Jaffe A, Taddei TH, Giannini EG, Ilagan-Ying YC, Colombo M, Strazzabosco M. Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook. Liver Int 2022; 42:2607-2619. [PMID: 36161463 PMCID: PMC10878125 DOI: 10.1111/liv.15432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common complication in patients with chronic liver disease and leads to significant morbidity and mortality. Liver disease and liver cancer are preventable by mitigating and managing common risk factors, including chronic hepatitis B and C infection, alcohol use, diabetes, obesity and other components of the metabolic syndrome. The management of patients with HCC requires treatment of the malignancy and adequate control of the underlying liver disease, as preserving liver function is critical for successful cancer treatment and may have a relevant prognostic role independent of HCC management. Hepatologists are the ideal providers to guide the care of patients with HCC as they are trained to identify patients at risk, apply appropriate surveillance strategies, assess and improve residual liver function, evaluate candidacy for transplant, provide longitudinal care to optimize and preserve liver function during and after HCC treatment, survey for cancer recurrence and manage its risk factors, and prevent and treat decompensating events. We highlight the need for a team-based holistic approach to the patient with liver disease and HCC and identify necessary gaps in current care and knowledge.
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Affiliation(s)
- Ariel Jaffe
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Smilow Cancer Hospital and Liver Cancer Program, New Haven, CT, USA
| | - Tamar H. Taddei
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ysabel C. Ilagan-Ying
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Smilow Cancer Hospital and Liver Cancer Program, New Haven, CT, USA
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11
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Gofton C, Agar M, George J. Early Implementation of Palliative and Supportive Care in Hepatocellular Carcinoma. Semin Liver Dis 2022; 42:514-530. [PMID: 36193677 DOI: 10.1055/a-1946-5592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Early palliative and supportive care referral is the standard of care for many malignancies. This paradigm results in improvements in patients' symptoms and quality of life and decreases the costs of medical care and unnecessary procedures. Leading oncology guidelines have recommended the integration of early referral to palliative and supportive services to care pathways for advanced malignancies. Currently, early referral to palliative care within the hepatocellular carcinoma (HCC) population is not utilized, with gastroenterology guidelines recommending referral of patients with Barcelona Clinic Liver Cancer stage D to these services. This review addresses this topic through analysis of the existing data within the oncology field as well as literature surrounding palliative care intervention in HCC. Early palliative and supportive care in HCC and its impact on patients, caregivers, and health services allow clinicians and researchers to identify management options that improve outcomes within existing service provisions.
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Affiliation(s)
- Cameron Gofton
- Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia.,Storr Liver Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Meera Agar
- Department of Palliative Care, University of Technology Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Medicine, University of Sydney, Camperdown and Darlington Campus, Camperdown, New South Wales, Australia
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12
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Cisneros-Garza L, González-Huezo M, Moctezuma-Velázquez C, Ladrón de Guevara-Cetina L, Vilatobá M, García-Juárez I, Alvarado-Reyes R, Álvarez-Treviño G, Allende-Pérez S, Bornstein-Quevedo L, Calderillo-Ruiz G, Carrillo-Martínez M, Castillo-Barradas M, Cerda-Reyes E, Félix-Leyva J, Gabutti-Thomas J, Guerrero-Ixtlahuac J, Higuera-de la Tijera F, Huitzil-Melendez D, Kimura-Hayama E, López-Hernández P, Malé-Velázquez R, Méndez-Sánchez N, Morales-Ruiz M, Ruíz-García E, Sánchez-Ávila J, Torrecillas-Torres L. The second Mexican consensus on hepatocellular carcinoma. Part II: Treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:362-379. [DOI: 10.1016/j.rgmxen.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 10/25/2022] Open
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13
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Lee CH, Yen TH, Hsieh SY. Outcomes of Geriatric Patients with Hepatocellular Carcinoma. Curr Oncol 2022; 29:4332-4341. [PMID: 35735455 PMCID: PMC9221899 DOI: 10.3390/curroncol29060346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The treatment modalities and outcomes of geriatric patients with hepatocellular carcinoma (HCC) remain controversial. This retrospective observational cohort study compared the outcomes of HCC between geriatric and younger patients. Methods: The medical records of patients with HCC managed between January 2001 and December 2017 were retrieved from the Chang Gung Memorial Hospital Research Database. Patients were stratified by age into two groups: a geriatric group (65−75 years) and a younger group (<65 years). The two groups were matched through 1:2 propensity score matching (PSM) according to sex, cardiovascular disease, cerebrovascular attack, diabetes mellitus, cirrhosis, hepatitis, and hypertension. Results: Of the 11,033 patients with HCC, 2147 patients aged 65−75 years and 4294 patients aged <65 years were identified after 1:2 PSM. The Kaplan−Meier model revealed that the HCC outcomes in patients older than 65 years were not significantly different after 3 years (p = 0.060). Consistent results were also obtained when the laboratory data associated with HCC incidence were included in the Fine−Gray competing risk model after 1:2 PSM (p = 0.1695). The major risk factors for HCC survival were systemic immune-inflammation index (SII) ≥ 610 × 109 cells/L, advanced tumor stage, and model for end-stage liver disease (MELD) score, etc. Conclusion: Age was not an independent factor for mortality in patients with HCC in the first 3 years. Geriatric patients with HCC should be as aggressively managed as younger patients.
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Affiliation(s)
- Chern-Horng Lee
- Division of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (T.-H.Y.); (S.-Y.H.)
| | - Sen-Yung Hsieh
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Correspondence: (T.-H.Y.); (S.-Y.H.)
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14
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Abdel Wahab AHA, Hussein MM, Shouman SA, Fouad D, Kobaisi MH, El Habit O. Role of let7-g and miR-221 level as potential predictors for overall survival of hepatocellular carcinoma patients. Arab J Gastroenterol 2022; 23:151-158. [PMID: 35473687 DOI: 10.1016/j.ajg.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND STUDY AIMS Hepatocellular carcinoma (HCC) is one of the most common cancer types worldwide. A hallmark of epithelial-mesenchymal transition is the loss of epithelial E-cadherin, which is considered an epithelial differentiation marker. MicroRNAs serve vital roles in various biological processes in the cell via post-transcriptional gene regulation. Therefore, the present study aimed to investigate the involvement of certain miRNAs in the progression of HCC. PATIENTS AND METHODS A reverse transcription-quantitative PCR assay was conducted to detect the expression levels of 20 EMT-related miRNAs in 36 fresh tissue biopsies from patients with primary HCC compared with healthy controls. Gene expression levels, as well as immunohistochemistry assays, were performed for E-cadherin, ZEB1 and ZEB2 proteins. The correlation between their expression levels and different clinicopathological factors was also assessed. RESULTS A significant decrease of E-Cadherin and an increase in ZEB1 expression levels were identified in HCC groups compared with controls, while no significant changes for ZEB2 were found. The absence of E-cadherin membranous protein was observed in ∼48% of the cases examined. Moreover, ZEB1 protein was absent in 46% of E-cadherin positive cases. Upregulation of miR-182, miR-221 and miR-222 expression levels, and downregulation of let-7g, miR-9, miR-16, miR29c, miR122, miR-145, miR-148a, miR-193b, miR-194 and miR-215 expression levels were identified. A positive correlation between let7-g with E-Cadherin expression was reported. No significant association was identified between each of E-cadherin, ZEB1, ZEB2 or miRNAs examined with different clinicopathological features of the patients. Furthermore, the low expression of let7-g and high expression of miR-221 were associated with poorer survival. CONCLUSION Collectively, the present data suggested that let7-g functions as a tumor suppressor in the development of HCC via regulating E-Cadherin. Furthermore, both let7-g and miR-221 may be potential biomarkers for the outcomes of HCC patients.
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Affiliation(s)
| | - Manal M Hussein
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
| | - Samia A Shouman
- Department of Cancer Biology, National Cancer Institute, Cairo University, Egypt
| | - Dalia Fouad
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
| | - Mohamed H Kobaisi
- Department of Pathology, National Institute of Urology and Nephrology, Cairo, Egypt
| | - Ola El Habit
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
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15
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Genome-scale CRISPR-Cas9 knockout screening in hepatocellular carcinoma with lenvatinib resistance. Cell Death Discov 2021; 7:359. [PMID: 34795217 PMCID: PMC8602346 DOI: 10.1038/s41420-021-00747-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 12/26/2022] Open
Abstract
Lenvatinib is the first target drug approved for advanced hepatocellular carcinoma (HCC). However, the development of drug resistance is common, and the mechanisms of lenvatinib resistance and resistant targets in HCC are poorly understood. By using CRISPR/Cas9 library screening, we screened out two key resistance genes, neurofibromin 1(NF1), and dual specificity phosphatase 9 (DUSP9), as critical drivers for lenvatinib resistance in HCC. With RNAi knockdown and CRISPR/Cas9 knockout models, we further clarified the mechanisms by which NF1 loss reactivates the PI3K/AKT and MAPK/ERK signaling pathways, while DUSP9 loss activates the MAPK/ERK signaling pathways, thereby inactivating FOXO3, followed by degradation of FOXO3, finally induced lenvatinib resistance. We also screened out trametinib, a small molecule pathway inhibitor for MEK, that can be used to reverse resistance induced by NF1 and DUSP9 loss in HCC cells. Trametinib was still able to halt HCC growth even when NF1 was knocked out in mice. Collectively, the findings indicate that NF1 and DUSP9 takes critical role in lenvatinib resistance and may be novel specific targets and predictive markers for lenvatinib resistance in HCC.
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16
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Zhang H, Li Y, McConnell W. Predicting potential palliative care beneficiaries for health plans: A generalized machine learning pipeline. J Biomed Inform 2021; 123:103922. [PMID: 34607012 DOI: 10.1016/j.jbi.2021.103922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Recognizing that palliative care improves the care quality and reduces the healthcare costs for individuals in their end of life, health plan providers strive to better enroll the appropriate target population for palliative care. Current research has not adequately addressed challenges related to proactively select potential palliative care beneficiaries from a population health perspective. This study presents a Generalized Machine Learning Pipeline (GMLP) to predict palliative needs in patients using administrative claims data. The GMLP has five steps: data cohort creation, feature engineering, predictive modeling, scoring beneficiaries, and model maintenance. It encapsulates principles of population health management, business domain knowledge, and machine learning (ML) process knowledge with an innovative data pull strategy. The GMLP was applied in a regional health plan using a data cohort of 17,197 patients. Multiple ML models were turned and evaluated against a custom performance metric based on the business requirement. The best model was an AdaBoost model with a precision of 71.43% and a recall of 67.98%. The post-implementation evaluation of the GMLP showed that it increased the recall of high mortality risk patients, improved their quality of life, and reduced the overall cost. The GMLP is a novel approach that can be applied agnostically to the data and specific ML algorithms. To the best of our knowledge, it is the first attempt to continuously score palliative care beneficiaries using administrative data. The GMLP and its use case example presented in the paper can serve as a methodological guide for different health plans and healthcare policymakers to apply ML in solving real-world clinical challenges, such as palliative care management and other similar risk-stratified care management workflows.
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Affiliation(s)
- Hengwei Zhang
- University of Tampa, Sykes College of Business, 401 W Kennedy Blvd, Tampa, FL 33606 USA.
| | - Yan Li
- Claremont Graduate University , Center for Information Systems and Technology, 130 E. 9th Street - ABC 217, Claremont, CA 91711, USA.
| | - William McConnell
- Claremont Graduate University , School of Community and Global Health, 130 E. 9th Street, Claremont, CA 91711, USA.
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17
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Greten TF, Abou-Alfa GK, Cheng AL, Duffy AG, El-Khoueiry AB, Finn RS, Galle PR, Goyal L, He AR, Kaseb AO, Kelley RK, Lencioni R, Lujambio A, Mabry Hrones D, Pinato DJ, Sangro B, Troisi RI, Wilson Woods A, Yau T, Zhu AX, Melero I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma. J Immunother Cancer 2021; 9:e002794. [PMID: 34518290 PMCID: PMC8438858 DOI: 10.1136/jitc-2021-002794] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.
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Affiliation(s)
- Tim F Greten
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Medical College at Cornell University, New York, New York, USA
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Austin G Duffy
- The Mater Hospital/University College Dublin, Dublin, Ireland
| | - Anthony B El-Khoueiry
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Richard S Finn
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Lipika Goyal
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aiwu Ruth He
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robin Kate Kelley
- Department of Medicine (Hematology/Oncology), UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Riccardo Lencioni
- Department of Radiology, University of Pisa School of Medicine, Pisa, Italy
- Miami Cancer Institute, Miami, Florida, USA
| | - Amaia Lujambio
- Oncological Sciences Department, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donna Mabry Hrones
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Bruno Sangro
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Andrea Wilson Woods
- Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, Alabama, USA
| | - Thomas Yau
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Andrew X Zhu
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Jiahui Health, Jiahui International Cancer Center, Shanghai, China
| | - Ignacio Melero
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Foundation for Applied Medical Research (FIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
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18
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Verma M, Paik JM, Younossi I, Tan D, Abdelaal H, Younossi ZM. The impact of hepatocellular carcinoma diagnosis on patients' health-related quality of life. Cancer Med 2021; 10:6273-6281. [PMID: 34405568 PMCID: PMC8446553 DOI: 10.1002/cam4.4166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Background Patients with hepatocellular cancer (HCC) are known to have worse health‐related quality of life (HRQL) than the general population. However, the change in HRQL from before the diagnosis to after diagnosis remains unknown and is difficult to estimate. We aimed to compare HCC cases with matched controls to evaluate the differences in change in HRQL from before to after HCC diagnosis. Methods We performed propensity score‐matched analysis using the self‐reported HRQL data from the Surveillance, Epidemiology, and End Results registries (SEER) data linked with Medicare Health Outcomes Survey (MHOS) data (1998–2014). Cases were selected as Medicare beneficiaries (aged ≥65 years) who were diagnosed with HCC between their baseline assessment and follow‐up assessment. Matched controls were selected from the same data resource and the same time period to include subjects without cancer diagnosis by propensity scores. HRQL was assessed using the Medical Outcomes Study Short Form‐36 (SF‐36). Results The study included 62 subjects who developed HCC and 365 matched controls. Compared to their baseline HRQL scores, after diagnosis of HCC, subjects were more likely to report declines in scores related to the mental component of HRQL. When stratified by time since diagnosis, mental component remained significantly lower as the disease advanced. In contrast, only general health aspects of physical health worsened after HCC diagnosis. Conclusions Diagnosis of HCC has a profound negative impact on patients’ HRQL. Mental health component deteriorated significantly over time. The need of including mental health services within a multidisciplinary HCC care model is clearly evident.
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Affiliation(s)
- Manisha Verma
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Inova Health System, Falls Church, Virginia, USA
| | - James M Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Issah Younossi
- Center for Outcomes Research in Liver Diseases, Washington DC, USA
| | - Daisong Tan
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Hala Abdelaal
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Inova Health System, Falls Church, Virginia, USA.,Center for Outcomes Research in Liver Diseases, Washington DC, USA
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19
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Younossi ZM, Henry L. Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma. JHEP Rep 2021; 3:100305. [PMID: 34189448 PMCID: PMC8215299 DOI: 10.1016/j.jhepr.2021.100305] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/07/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023] Open
Abstract
The prevalence of hepatocellular carcinoma (HCC) is increasing worldwide, whereas that of most other cancers is decreasing. Non-alcoholic fatty liver disease (NAFLD), which has increased with the epidemics of obesity and type 2 diabetes, increases the risk of HCC. Interestingly, NAFLD-associated HCC can develop in patients with or without cirrhosis. A lack of awareness about NAFLD-related HCC has led to delays in diagnosis. Therefore, a large number of patients with HCC are diagnosed with advanced-stage HCC with low 5-year survival. In this context, increasing awareness of NAFLD and NAFLD-related HCC may lead to earlier diagnosis and more effective interventions.
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Key Words
- ALD, alcohol-related liver disease
- CVD, cardiovascular disease
- ELF, enhanced liver fibrosis
- FIB-4, fibrosis-4
- HCC, hepatocellular carcinoma
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PDGF, platelet-derived growth factor
- STAT3, signal transducer and activator of transcription 3
- TNF, tumour necrosis factor-α
- VEGF, vascular endothelial growth factor
- awareness
- cirrhosis
- natural history
- non-cirrhosis
- surveillance
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Affiliation(s)
- Zobair M. Younossi
- Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
- Medical Service Line. Inova Health Systems, Falls Church, VA, United States
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington DC, United States
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20
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Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease. ACTA ACUST UNITED AC 2021; 20:43-52. [PMID: 33868897 PMCID: PMC8035614 DOI: 10.1007/s11901-021-00562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
Abstract
Purpose of Review The current healthcare system is not fully equipped to provide comprehensive support for patients with advanced liver disease (ALD) and their caregivers resulting in concomitant suffering and reduced quality of life (QoL). Integration of palliative care (PC) within routine care has demonstrated benefits in improving symptoms and QoL and reducing healthcare utilization for other serious illnesses but has been underutilized or delayed for ALD care. The purpose of this article is to outline the domains and benefits of PC and discuss the misconceptions and barriers for PC integration, and healthcare delivery models supporting PC integration within ALD care. Recent Findings PC has eight key domains related to physical and mental health, goals for future care, and care of the caregivers. PC offers benefits to improve health outcomes and patient satisfaction and reduce healthcare utilization. To date there have been successful models of PC that are primarily hospital- or community-based; successful models have been PC specialist- or primary/generalist-led. Summary Concurrent PC within oncology has formed the basis for most evidence-based guidelines. PC integration within ALD care is still in its infancy. While amassing evidence in ALD, hepatology organizations can promote consensus-based integrated PC models that can guide research and practice efforts to increase supportive care for these patients in need and their family caregivers.
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21
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de Avila V, Paik JM, de Avila L, Henry L, Mohess D, Roche-Green A, Younossi ZM. Hospice care utilisation among elderly patients who died with hepatocellular carcinoma in the United States. JHEP Rep 2021; 3:100236. [PMID: 33748729 PMCID: PMC7970151 DOI: 10.1016/j.jhepr.2021.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND & AIMS The benefits of hospice care in Medicare recipients with hepatocellular carcinoma (HCC) have not been fully evaluated, which we aimed to study. METHODS We used nationally representative samples of the Medicare beneficiaries in the USA (2011-2016) to assess the impact of hospice care on the outcomes of patients with HCC. Hospice care benefits on the survival time, length of stay (LOS), 30-day readmissions, and daily charges during the last year and month of life were assessed by logistic regression and generalised linear regression. RESULTS Among 2,230 Medicare beneficiaries with HCC (mean age, 74.9 years; non-Hispanic White 79.1%; male 66.6%), median survival from HCC diagnosis was 68 days; 556 (24.9%) received hospice services; median hospice LOS was 12 days (4-35 days). Hospice users increased from 20.1% to 31.1% over time, driven by enrolment ≤15 days (45.1-59.2%, respectively). In the last year of life, hospice users (vs. no hospice care) had longer median survival time (76.5 vs. 66 days), lower in-hospital mortality (1.1% vs. 25.5%) and lower median daily charges ($951 vs. $1,004) despite more inpatient admissions and higher comorbid diseases. Hospice enrolment was associated with 48.6% reduction in daily charges (95% CI: -54.9% to -41.5%). Longer hospice LOS was associated with lower rates of healthcare utilisation. Patients with chronic liver disease were less likely to enrol in hospice care (odds ratio = 0.18, 95% CI: 0.14-0.24). CONCLUSIONS Although hospice provides a significant decrease in healthcare utilisation and some benefit in survival, most care is given in the last 2 weeks of life. Efforts to encourage earlier use of hospice services must continue. LAY SUMMARY The purpose of hospice care is to provide comfort and lessen suffering at the end of life. Hospice care allows one to die outside the hospital environment which is the wish of most people. However, we found that among persons aged 65 years and older who were diagnosed with liver cancer (which has a poor prognosis), only 25% were enrolled in hospice care and the majority used a hospice only in the last weeks of life. This is a disheartening finding as liver cancer patients with longer hospice enrolment had lower costs and improved survival. We suggest that healthcare practitioners consider discussion of palliative and hospice care routinely with patients suffering from liver cancer.
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Affiliation(s)
- Victor de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - James M. Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Denise Mohess
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Alva Roche-Green
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
- Inova Medicine, Inova Health Systems, Falls Church, VA, USA
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22
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Laube R, Sabih AH, Strasser SI, Lim L, Cigolini M, Liu K. Palliative care in hepatocellular carcinoma. J Gastroenterol Hepatol 2021; 36:618-628. [PMID: 32627853 DOI: 10.1111/jgh.15169] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma is a common cancer with a poor prognosis, associated with high economic costs and a significant burden of disease. While it is often asymptomatic in the early stages, patients may experience great discomfort from advanced disease, treatment adverse effects, or decompensation of underlying cirrhosis. Palliative care has the potential to markedly improve quality of life, physical, and psychological symptoms in patients with end-stage liver disease, and has been shown to prolong survival in some nonhepatocellular carcinoma malignancies. However, this service is underutilized in hepatocellular carcinoma, and referrals are frequently late due to factors such as stigmatization, inadequate resources, lack of education for nonpalliative care physicians and inadequate modeling for integration of palliative and supportive care within liver disease services. In the future, education workshops, population-based awareness campaigns, increased funding and improved models of care, may improve the uptake of palliative care and subsequently optimize patient care, particularly towards the end of life.
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Affiliation(s)
- Robyn Laube
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Abdul-Hamid Sabih
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lynn Lim
- Palliative Care Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Maria Cigolini
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Palliative Care Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Liver Injury and Cancer Program, Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
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Buranupakorn T, Thangsuk P, Patumanond J, Phinyo P. Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13050992. [PMID: 33673534 PMCID: PMC7956840 DOI: 10.3390/cancers13050992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Hepatocellular carcinoma (HCC) is a common and aggressive liver cancer. As most patients are diagnosed during an incurable stage of the disease, they usually face great suffering during the end-of-life period. Palliative care can improve the patient’s quality of life and alleviate both physical and psychological symptoms. However, the discipline is underutilized due to a common misconception that it will accelerate the patient’s death. We emulated a hypothetical target trial to evaluate the causal effect of palliative care consultation on the survival time of patients diagnosed with HCC from retrospective observational data of a Thai tertiary care center. Although no clear survival benefit or harm was identified, palliative care consultation significantly reduced the use of unnecessary life-sustaining intervention, healthcare costs, and the risk of dying in the hospital among patients with HCC during their end-of-life period. Abstract Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded.
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Affiliation(s)
- Tassaya Buranupakorn
- Department of Family Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand; (T.B.); (P.T.)
| | - Phaviga Thangsuk
- Department of Family Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand; (T.B.); (P.T.)
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR) Cluster, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53-935-180
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Ghezelsefli Z, Ahmadi F, Mohammadi E, RN MP. Experiences of End-of-Life Care of Older Adults with Cancer From the Perspective of Stakeholdersin Iran: A Content Analysis Study. Asian Pac J Cancer Prev 2021; 22:295-300. [PMID: 33507711 PMCID: PMC8184189 DOI: 10.31557/apjcp.2021.22.1.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/10/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe end-of-life care forolder adults with cancer admitted to the hospital in Tehran, Iranto determine if there were any gaps in care for older adultsthat can be improved. MATERIALS This study used a qualitative descriptive study design. In total, 37 individualsincluding patients, healthcare team members, and family caregivers, participated in the study. Semi-structured interviews using topic guides were conducted, and the thematic content analysis method described by Braun and Clarke (2006), was used to analyze the data. RESULTS In total, 37 Iranian participants (12 male and 25 female), including 14 nurses, 3 oncologists, 1 social worker, 1 chaplain, 1 psychologist, 11 family members and 6 patientsinterviewed.Our main themes of end-of-life carewere:1) barriers to providing and receiving quality care for families and patients; and 2) coping strategies and empowerment of families and patients. CONCLUSION Healthcare providers are recommended to familiarize themselves with the burden faced by patients and family caregivers who take care of older adults with chronic diseases at home, and they should organize their supportive and consulting actions. In order to improve the quality of life of older patientsand their family caregivers.
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Affiliation(s)
- Zohreh Ghezelsefli
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Martine Puts RN
- Department of Nursing, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada.
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Abstract
In the health care setting, and especially in cancer patients nearing the end of life, administrators, medical staff, patients, and families face challenges of a social, legal, religious, and cultural nature in the process of care. The present study aimed to perform a metasynthesis of qualitative studies conducted on providing end-of-life care for cancer patients. The present metasynthesis was conducted using Sandelowski and Barroso's method. A literature search was performed in PubMed, Scopus, Web of Science, and Embase databases, from the inception to date, and a total of 21 articles were identified as eligible for inclusion in the study. Critical Appraisal Skills Programme (CASP) criteria were used for assessing the articles, and data were analyzed by the subject review. Six themes were extracted for end-of-life care including psychological support, palliative support, educational-counseling support, spiritual support, preferential support, and supportive interactions, each comprising a number of categories. The most frequently mentioned categories were high-value care (67%) and adaptive acceptance (57%). The findings of this metasynthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The present study showed that providing high-value care and facilitating adaptive acceptance are important constituents of a holistic strategy for providing end-of-life care to cancer patients.
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Alqahtani SA, Sanai FM, Alolayan A, Abaalkhail F, Alsuhaibani H, Hassanain M, Alhazzani W, Alsuhaibani A, Algarni A, Forner A, Finn RS, Al-hamoudi WK. Saudi Association for the Study of Liver diseases and Transplantation practice guidelines on the diagnosis and management of hepatocellular carcinoma. Saudi J Gastroenterol 2020; 26:S1-S40. [PMID: 33078723 PMCID: PMC7768980 DOI: 10.4103/sjg.sjg_477_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Saleh A. Alqahtani
- Liver Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Faisal M. Sanai
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ashwaq Alolayan
- Adult Medical Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Faisal Abaalkhail
- Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Hamad Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Abdullah Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Algarni
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Richard S Finn
- Division of Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California,United States
| | - Waleed K. Al-hamoudi
- Liver Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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27
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Tseng HC, Xiong W, Badeti S, Yang Y, Ma M, Liu T, Ramos CA, Dotti G, Fritzky L, Jiang JG, Yi Q, Guarrera J, Zong WX, Liu C, Liu D. Efficacy of anti-CD147 chimeric antigen receptors targeting hepatocellular carcinoma. Nat Commun 2020; 11:4810. [PMID: 32968061 PMCID: PMC7511348 DOI: 10.1038/s41467-020-18444-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
Chimeric antigen receptor (CAR) therapy is a promising immunotherapeutic strategy for treating multiple refractory blood cancers, but further advances are required for solid tumor CAR therapy. One challenge is identifying a safe and effective tumor antigen. Here, we devise a strategy for targeting hepatocellular carcinoma (HCC, one of the deadliest malignancies). We report that T and NK cells transduced with a CAR that recognizes the surface marker, CD147, also known as Basigin, can effectively kill various malignant HCC cell lines in vitro, and HCC tumors in xenograft and patient-derived xenograft mouse models. To minimize any on-target/off-tumor toxicity, we use logic-gated (log) GPC3–synNotch-inducible CD147-CAR to target HCC. LogCD147-CAR selectively kills dual antigen (GPC3+CD147+), but not single antigen (GPC3-CD147+) positive HCC cells and does not cause severe on-target/off-tumor toxicity in a human CD147 transgenic mouse model. In conclusion, these findings support the therapeutic potential of CD147-CAR-modified immune cells for HCC patients. Chimeric antigen receptor (CAR)-based therapy for the treatment of liver cancer represents a promising therapeutic strategy. Here the authors show that CD147-targeting CAR-NK or CAR-T can induce anti-tumor activity against hepatocellular carcinoma in vitro and in vivo.
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Affiliation(s)
- Hsiang-Chi Tseng
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Wei Xiong
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.,Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, 6550 Fannin Street, SM8026, Houston, TX, 77030, USA
| | - Saiaditya Badeti
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Yan Yang
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Minh Ma
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Ting Liu
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Carlos A Ramos
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Gianpietro Dotti
- Department of Microbiology and Immunology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Luke Fritzky
- Imaging core facility, Rutgers University-New Jersey Medical School, 205 South Orange Avenue, Newark, NJ, 07103, USA
| | - Jie-Gen Jiang
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Qing Yi
- Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, 6550 Fannin Street, SM8026, Houston, TX, 77030, USA
| | - James Guarrera
- Department of Surgery, New Jersey Medical School, Rutgers-The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07101, USA
| | - Wei-Xing Zong
- School of Pharmacy, Rutgers-The State University of New Jersey, Newark, 164 Frelinghuysen Road Piscataway, NJ, 08854, USA
| | - Chen Liu
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Dongfang Liu
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA. .,Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07101, USA.
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Hepatocellular Carcinoma: Practice Guidelines Update for the Advanced Practice Provider. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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29
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Optimizing Cancer Treatment for Older Adults. Clin Ther 2018; 40:502-503. [DOI: 10.1016/j.clinthera.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 01/30/2023]
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30
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Shader RI. Cancer in the Elderly. Clin Ther 2018; 40:497-500. [DOI: 10.1016/j.clinthera.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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