{"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_n81kbjgs"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}
Chronic liver disease (CLD) is commonly associated with a significant burden of symptoms that should be addressed in the context of treatment of the underlying liver disease. Common liver-disease–associated symptoms, such as pruritus, fatigue/ sleep disorders, volume overload, cramping and pain, and depression and anxiety significantly impact the quality of life in our patients living with CLD. The recognition that symptoms need to be acknowledged and addressed is integral to not only the clinical care of patients but also in the design of research studies that hope to evaluate therapeutic interventions for CLD.1 Furthermore, there has been an increasing focus in our field on the importance of early palliative care involvement for patients with advanced liver disease to optimize symptom management, which is a key component of the first Palliative Care guidance recently developed by the American Association for the Study of Liver Diseases (AASLD).2 Prevalence and types of symptoms among patients with CLD vary by liver disease etiology, liver disease stage, and burden of comorbidities, but universally symptom burden is high among patients with end-stage liver disease (ESLD). For example, per a large systematic review evaluating symptoms drawing data from 80 studies, pain symptoms occurred in 30%–79% of individuals, muscle cramps occurred in 56%–68% of individuals, sleep disturbances occurred in 26%–77%, and psychological symptoms occurred in 4.5%–64% of patients with ESLD.3 Thus there is a need to recognize and systematically address symptom burden, with an approach that tracks symptoms over time and prioritizes symptom management.2 Considerations specific to ESLD should be made before initiating medication therapy, and multidisciplinary care management may be needed to optimize symptoms control, such as the incorporation of physical therapy, behavioral management, and procedural approaches to optimize pain management. Furthermore, studies focused on specific symptom management in patients with ESLD, such as the novel PICCLES trial demonstrating the benefit of a pickle juice intervention on cramp symptoms in individuals living with cirrhosis, are needed.4 In this CLD series, we evaluate our current approaches to the management of commonly occurring symptoms in patients with CLD: pruritus, fatigue/ sleep disorders, volume overload, cramping and pain, and depression and anxiety. Current data on the approach to clinical management of CLD symptoms are discussed for each of these commonly reported symptoms that affect so many of our patients with CLD.
Export {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_su6ge2ka"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}
HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6-4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7-14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99-10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25-38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.
