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Carcinome hépatocellulaire : quels soins de confort ?

Hepatocellular carcinoma: What are the palliative care options?

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Oncologie

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Résumé

Les soins de confort doivent être instaurés précocement chez les patients ayant un carcinome hépatocellulaire sur cirrhose. En effet, leur qualité de vie est souvent altérée. Les troubles du sommeil peuvent bénéficier de mesures hygiéniques simples, voire d’hydroxyzine à faible dose. Le traitement médicamenteux de la dépression est complexe, les inhibiteurs de la recapture de la sérotonine seraient à préférer. La dénutrition amenant à la sarcopénie justifie des mesures parfois complexes; les acides aminés branchés pourraient être intéressants, le point crucial est de bien apprécier les apports alimentaires et de tenter de les renforcer en allant au besoin jusqu’à l’alimentation orale par sonde. Les traitements médicamenteux des douleurs feront appel au paracétamol et aux morphiniques (morphine, hydromorphone, fentanyl surtout) en prenant le temps d’une bonne titration (doses plus faibles, intervalles plus longs); ils sont encore trop souvent sous-utilisés malgré le risque assez faible. Les AINS sont par contre contre-indiqués. Un travail d’équipe en association avec les médecins de soins palliatifs est fondamental, ainsi qu’un contact de qualité avec le patient et ses proches.

Abstract

Palliative care must be proposed early to hepatocellular carcinoma patients due to the alteration brought about by the disease in the quality of life. Sleep difficulty is improved by proper sleep hygiene and eventually hydroxyzine low dose. Depression may require serotonin recapture inhibitors. For malnutrition and sarcopenia, a good assessment of nutritional status will help; frequent meals, a late evening snack, eventually oral nutritional supplements, and sometimes enteral nutrition are of major importance; branched-chain amino acids can be a good support. Pain management is frequently underused; paracetamol can be safely used (2–3 g/d); Non Steroidal Antiinflammatory Drugs (NSAIDs) must be avoided; opiates are the second line treatment of choice but are started at low and infrequent doses with slow increment. In all cases, an honest communication with the patients and appropriate care of the family are key.

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Authors and Affiliations

  1. Département d’oncologie médicale, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, F-13273, Marseille, France

    J. -L. Raoul & M. Gilabert

  2. Unité de soins palliatifs, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, F-13273, Marseille, France

    G. Capodano

Authors
  1. J. -L. Raoul
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  2. M. Gilabert
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  3. G. Capodano
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Correspondence to J. -L. Raoul.

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Raoul, J.L., Gilabert, M. & Capodano, G. Carcinome hépatocellulaire : quels soins de confort ?. Oncologie 19, 184–187 (2017). https://doi.org/10.1007/s10269-017-2714-4

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  • DOI: https://doi.org/10.1007/s10269-017-2714-4

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