key: cord-0913654-ihc0an83
authors: Sharma, Rohini; Pinato, David J.
title: Management of Hepatocellular Cancer in the time of SARS‐CoV‐2
date: 2020-05-16
journal: Liver Int
DOI: 10.1111/liv.14517
sha: 3da31cc5e8b7a49a4f6d8ed6d7016fd2de3ab892
doc_id: 913654
cord_uid: ihc0an83

As COVID‐19 the disease caused by SARS‐CoV‐2 continues to have a profound impact on global health, there have been a number of guidelines recently published addressing the management of patients with liver disease during the COVID‐19 pandemic including the recently published EASL‐ESCMID Position Paper, guidelines issued by the International Liver Cancer Association and the American Association for the Study of Liver Diseases (1‐3). All publications present a sound discussion regarding the challenges face by both patients and clinicians alike in the management of chronic liver disease in the setting of this ongoing pandemic.

Currently, there is no evidence suggesting that tyrosine kinase inhibitors increase the risk COVID-19 and currently our center has continued their use on an outpatient basis in those patients who fit EASL guidelines (7) . There is sufficient evidence to suggest that dose per se does not impact on survival outcome and given the potential for first cycle tachyphylaxis, we have taken a conservative approach to treatment with 50% dose reduction initially with a view to dose escalation with subsequent cycles (8) . Many centers are able to dispense two-month supply of medications, and where possible we have encouraged patients to purchase home blood pressure monitors with bloods and urinalysis to be conducted at local practices every two months. There is clearly no role for agents in the palliative setting that have no survival benefit including extensive TACE, radioembolisation and immunotherapy. For these agents, the risk of COVID-19 infection outweighs any benefit and these patients should be offered best supportive care.

The role of the clinical nurse specialist and the palliative care team cannot be underestimated in management of HCC and communication is central in successful management of these patients. A key discussion with patients with BLCL-C and D disease will revolve around advance care planning and do not resuscitate orders in the setting of the current pandemic.

There is sound evidence that patients and their carers benefit from advanced planning and given the contagious and deadly nature of COVID-19, we believe that this should be a key As the pandemic evolves, it is clear we will be increasingly reliant on novel telecommunication methods to deliver patient care with close collaboration with community health teams to ensure we can deliver the best possible support to patients and their families. . This article is protected by copyright. All rights reserved Accepted Article

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