# Symptom burden in end-stage liver disease: a prospective cohort study of the symptoms experienced by patients and the role of palliative care

## TL;DR

This study shows that palliative care can significantly reduce symptoms like pain and fatigue in patients with severe liver disease.

## Contribution

The study demonstrates the effectiveness of palliative care in managing symptom burden in end-stage liver disease patients.

## Key findings

- Palliative care reduced pain intensity from 86.7% to 23.1% in patients with end-stage liver disease.
- Patients receiving palliative care reported higher symptom burden but showed significant improvement in symptom management.
- A symptom assessment scale was found to be simple and effective for evaluating symptom prevalence in ESLD patients.

## Abstract

Liver disease is a leading cause of morbidity and mortality. Patients with end-stage liver disease (ESLD) experience multiple physical symptoms. Despite the poor prognosis and significant symptom burden, palliative care integration remains limited.

To assess the symptom burden in ESLD patients, the viability of applying a symptom scale in routine evaluations, and to assess the impact of palliative care on symptom management.

Observational, prospective cohort study.

We prospectively included patients with chronic liver disease following their first episode of decompensation or diagnosis of hepatocarcinoma (HCC). Data collected included patient demographics, ESLD etiology, history of decompensation, and patient-reported symptom burden. Two-sided tests were used to identify factors of disease severity and evaluate the benefits of palliative care intervention.

Forty-four patients were assessed, divided into two cohorts: palliative care cohort (52.3%; n = 23) and hepatology care cohort (47.7%; n = 21). Patients in the palliative care cohort were older (69.35 ± 11.71 vs 59.86 ± 7.11 years; p = 0.002), had lower functional status (59.13 ± 2.51 vs 72.38 ± 2.92; p = 0.002), and higher prevalence of unstable decompensated cirrhosis (60.9% vs 28.6%; p = 0.043) and HCC (p < 0.001). This cohort reported a higher overall symptom burden, with rates of 82.6% for asthenia, 65.2% for pain, and 56.5% for anorexia. Palliative care interventions tended to reduce the prevalence of pain, anorexia, and dyspnea, with a significant decrease in pain intensity from 86.7% to 23.1% (p = 0.008) and asthenia intensity from 100% to 84.2% (p < 0.001).

Significant differences in symptom prevalence were observed between the two cohorts, likely due to specific clinical characteristics of each group. The use of a symptom assessment scale proved to be simple and effective, revealing a high prevalence of symptoms. Palliative care was associated with a positive impact on symptom management.

NCT06181474.

Managing symptoms in advanced liver disease: how palliative care helps

Liver disease is a major health issue, with people with severe liver disease often facing many uncomfortable symptoms. This study aimed to understand the symptoms experienced by patients with severe liver disease, how these symptoms relate to the severity of their condition, and the way palliative care could help manage these symptoms. The researchers included patients who had recently experienced a worsening of their condition or were diagnosed with liver cancer. The study involved 44 patients, divided into two groups: one receiving palliative care (23 patients) and another receiving standard liver care (21 patients). The palliative care group had older patients with more severe symptoms. Palliative care was found to help reduce the pain and improve the management of other symptoms. The study found notable differences in symptoms between the two groups, likely because of the unique health conditions of each one of them. Overall, palliative care can have a positive effect on managing symptoms for those patients.