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.

Brian D Mikolasko

Khaldoun Almhanna

Dana Guyer

Annals of Palliative Medicine

ANNALS OF PALLIATIVE MEDICINE (ANN PALLIAT MED; PRINT ISSN 2224-5820; ONLINE ISSN 2224-5839) 是一本开放获取、国际同行评议的期刊，自 2012 年起每季度出版一次，提供在线版和印刷版。该期刊的目的是为姑息医学学科的医疗保健提供者提供最新和最前沿的信息和专业支持，以提高患者及其家人和护理人员的生活质量。

The Annals of Palliative Medicine (ANN PALLIAT MED; Print ISSN 2224-5820; Online ISSN 2224-5839) is an open-access, internationally peer-reviewed journal that has been published quarterly since 2012, offering both online and print versions. The journal aims to provide healthcare providers in the field of palliative medicine with the latest and cutting-edge information and professional support to enhance the quality of life for patients, their families, and caregivers.

《Annals of Palliative Medicine》（ANN PALLIAT MED；印刷版 ISSN 2224-5820；在线版 ISSN 2224-5839）是一本开放获取的国际同行评审期刊，自2012年起每季度出版一次，提供在线和印刷版。该期刊旨在为姑息医学领域的医疗保健提供者提供最新的前沿信息和专业支持，以提升患者及其家属和护理人员的生活质量。

Category	Quartile
医学	4
医学, 卫生保健与服务	4

Palliative care and hepatobiliary malignancies: say no to late referral

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