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Caso clínico de carcinoma hepatocelular : a importância dos cuidados paliativos e cuidados paliativos domiciliários
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O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada com cancro em todo o mundo. Afeta principalmente indivíduos com doença hepática pré-existente nomeadamente, cirrose hepática e hepatite crónica. Os cuidados paliativos (CP) têm como principal objetivo melhorar a qualidade de vida dos doentes e das suas famílias, oferecendo suporte físico, emocional e espiritual. Por sua vez, os Cuidados Paliativos Domiciliários (CPD) têm demonstrado um impacto significativo na qualidade de vida do doente oncológico e da sua família. Caso Clínico: Doente do sexo feminino, 64 anos, natural da Índia, lojista. Infeção pelo vírus da hepatite C (VHC) com 30 anos de evolução, com acompanhamento médico desde então, tendo em 2017 feito tratamento curativo em Portugal. Porém, em 2021, desenvolve cirrose hepática associada a VHC descompensada. Em março de 2021, é diagnosticada com Carcinoma Hepatocelular, classificação de estadiamento BCLC-C (Barcelona Clínic Liver Cancer). Inicia quimioterapia (QT) em abril de 2021 com lenvatinib, suspendendo por doença hepática em progressão BCLC-D, ECOG PS 3 (Eastern Cooperative Oncology Group Performance Status Scale). Tem várias complicações associadas ao quadro, nomeadamente: hemorragia digestiva alta por rotura de varizes esofágicas, encefalopatia porto-sistémica precipitada por infeção do trato urinário e vários episódios de ascite com paracenteses descompressivas de conforto. Em agosto de 2021, tem decisão em Reunião Multidisciplinar de Tumores Hepáticos para Best Supportive Care, iniciando seguimento em CP e acompanhada com CPD até ao seu falecimento, a julho de 2022. Objetivos: Tendo por base uma revisão teórica sobre CHC, CP e CPD, à luz de um caso clínico de uma doente com CHC em CPD, esta tese tem como principais objetivos: avaliar importância dos CPD para o doente e a sua família, bem como analisar legislação projetos e recursos disponíveis em Portugal e refletir a importância da integração dos cuidados numa abordagem centrada no doente. Metodologia: Revisão bibliográfica utilizando como motor de pesquisa a base de dados online: PubMed. As palavras-chave que foram utilizadas para a pesquisa foram ‘hepatocellular carcinoma’, ‘cirrhosis’, ‘hepatitis C’ e ‘paliative care’. Os critérios de inclusão aplicados para selecionar os artigos foram estudos que incluíssem pelo menos uma das seguintes variáveis: epidemiologia, fisiopatologia, diagnóstico, tratamento ou complicações e abordagem paliativa do Carcinoma Hepatocelular. Os tipos de estudos a incluir foram: revisões sistemáticas, ensaios clínicos, estudos de corte prospetivos e retrospetivos e estudos descritivos. Sempre que pertinente, não foi definida limitação relativa à língua ou à data de publicação dos artigos. No entanto, foi dada preferência a documentos de língua inglesa e portuguesa, publicados nos últimos 5 anos. Conclusão: Os CP e CPD revelam-se como uma ferramenta essencial na prestação de cuidados em doentes com CHC. A prestação de cuidados centrados no doente permite a melhoria da qualidade de vida do doente e a dignificação dos cuidados médicos. Em Portugal, existe a necessidade de restruturação e integração dos CP de modo que os doentes e as famílias possam usufruir de cuidados estruturados que promovam o bem-estar dos doentes.
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. It primarily affects individuals with pre-existing liver diseases, namely hepatic cirrhosis and chronic hepatitis. Palliative care (PC) aims to enhance the quality of life for patients and their families by providing physical, emotional and spiritual support. Home-based Palliative Care (HPC) has demonstrated a significant impact on the quality of life for cancer patients and their families. Clinical Case: A 64-year-old female patient, native of India, shopkeeper, personal history of Hepatitis C Virus (HCV) infection with 30 years of progression, receiving medical care since then, underwent curative treatment in Portugal in 2017. However, in 2021, she developed decompensated liver cirrhosis associated with HCV. In March 2021, she was diagnosed with Hepatocellular Carcinoma (HCC) BCLC-C. Chemotherapy was started in April 2021 with lenvatinib but was interrupted due to progressing liver disease BCLC-D, ECOG PSS 3. The patient faced various complications, including upper gastrointestinal bleeding due to esophageal varices rupture, portosystemic encephalopathy precipitated by an urinary tract infection and multiple episodes of ascites requiring decompressive paracenteses for comfort. In August 2021, a Multidisciplinary Meeting on Hepatic Tumors Meeting decided on Best Supportive Care. The patient received HPC until her death in July 2022. Objectives: Based on a theoretical review of HCC, PC, and HPC and starting from a clinical case of a patient with HCC in HPC, this thesis aims to assess the importance of HPC for the patient and their family. Additionally, it seeks to analyze legislation, projects, and resources available in Portugal and reflect on the importance of integrating care in a patient-centered approach. Methodology: A literature review was performed using the PubMed online database. Keywords used for the search included 'hepatocellular carcinoma,' 'cirrhosis,' 'hepatitis C,' and 'palliative care.' Inclusion criteria were studies incorporating at least one of the following variables: epidemiology, pathophysiology, diagnosis, treatment, complications and palliative approach to Hepatocellular Carcinoma. The types of studies included were systematic reviews, clinical trials, prospective and retrospective cohort studies and descriptive studies. Whenever applicable, no limitation was set regarding the language or publication date of the articles. However, preference was given to documents in English and Portuguese, published in the last 5 years. Conclusion: PC and HPC emerge as essential tools in providing care for HCC patients. Patient-centered care enables improvement in the patient's quality of life and dignifies medical care. In Portugal, there is a need for restructuring and integrating palliative care to ensure that patients and their families can benefit from well-organized care promoting the well-being of patients.
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. It primarily affects individuals with pre-existing liver diseases, namely hepatic cirrhosis and chronic hepatitis. Palliative care (PC) aims to enhance the quality of life for patients and their families by providing physical, emotional and spiritual support. Home-based Palliative Care (HPC) has demonstrated a significant impact on the quality of life for cancer patients and their families. Clinical Case: A 64-year-old female patient, native of India, shopkeeper, personal history of Hepatitis C Virus (HCV) infection with 30 years of progression, receiving medical care since then, underwent curative treatment in Portugal in 2017. However, in 2021, she developed decompensated liver cirrhosis associated with HCV. In March 2021, she was diagnosed with Hepatocellular Carcinoma (HCC) BCLC-C. Chemotherapy was started in April 2021 with lenvatinib but was interrupted due to progressing liver disease BCLC-D, ECOG PSS 3. The patient faced various complications, including upper gastrointestinal bleeding due to esophageal varices rupture, portosystemic encephalopathy precipitated by an urinary tract infection and multiple episodes of ascites requiring decompressive paracenteses for comfort. In August 2021, a Multidisciplinary Meeting on Hepatic Tumors Meeting decided on Best Supportive Care. The patient received HPC until her death in July 2022. Objectives: Based on a theoretical review of HCC, PC, and HPC and starting from a clinical case of a patient with HCC in HPC, this thesis aims to assess the importance of HPC for the patient and their family. Additionally, it seeks to analyze legislation, projects, and resources available in Portugal and reflect on the importance of integrating care in a patient-centered approach. Methodology: A literature review was performed using the PubMed online database. Keywords used for the search included 'hepatocellular carcinoma,' 'cirrhosis,' 'hepatitis C,' and 'palliative care.' Inclusion criteria were studies incorporating at least one of the following variables: epidemiology, pathophysiology, diagnosis, treatment, complications and palliative approach to Hepatocellular Carcinoma. The types of studies included were systematic reviews, clinical trials, prospective and retrospective cohort studies and descriptive studies. Whenever applicable, no limitation was set regarding the language or publication date of the articles. However, preference was given to documents in English and Portuguese, published in the last 5 years. Conclusion: PC and HPC emerge as essential tools in providing care for HCC patients. Patient-centered care enables improvement in the patient's quality of life and dignifies medical care. In Portugal, there is a need for restructuring and integrating palliative care to ensure that patients and their families can benefit from well-organized care promoting the well-being of patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Carcinoma hepatocelular Cirrose Hepatite C Cuidados paliativos Cuidados paliativos domiciliários