Palliative care and hepatobiliary malignancies: say no to late referral.

Hepatobiliary malignancies (HBMs), primarily hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), share the common traits of having a generally poor prognosis, late presentation, and high symptom burden related to both the disease process itself and underlying poor liver function. The incidences of both malignancies have been rising in recent decades for unclear reasons. Curative options remain limited given the general aggressive disease course despite advances in diagnosis, therapies, and surgery. Early integration of palliative care into the routine care of patients with HBMs is an essential, but underutilized, component of care to improve the functional and symptomatic quality of the lives of patients and their families. While formal guidelines for its integration are currently lacking, palliative care can and should be provided in parallel to disease specific care at any stage to address the physical, emotional, and spiritual needs of patients with HBMs. In this review, the special needs of this patient population are examined ranging from early symptom management at the time of diagnosis all the way through to end-oflife care. Key barriers that prevent the early provision of palliative care for patients with HBMs are identified and discussed and recommendations provided on how to improve early integration.