1School of Medicine and Health, UNSW, Sydney, New South Wales, Australia.
2Gastroenterology and Hepatology Department, St George Hospital, Sydney, New South Wales, Australia.
3Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
4IMPACCT, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
5Palliative Medicine, Calvary Hospital Kogarah, Kogarah, New South Wales, Australia.
6Clinical Ethics Service, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia.
7Sydney Health Ethics, The University of Sydney, Camperdown, New South Wales, Australia.
8UNSW Medicine & Health, St George and Sutherland Clinical Campus.
9Palliative Medicine Department, St George Hospital, Sydney, New South Wales, Australia.
Hepatocellular carcinoma (HCC) is a deadly and burdensome form of liver cancer with an increasing global prevalence. Its course is unpredictable as it frequently occurs in the context of underlying end-stage liver disease, and the associated symptoms and adverse effects of treatment cause severe suffering for patients. Palliative care (PC) is a medical specialty that addresses the physical, emotional, and spiritual needs of patients and their carers in the context of life-limiting illness. In other cancers, a growing body of evidence has demonstrated that the early introduction of PC at diagnosis improves patient and carer outcomes. Despite this, the integration of palliative care at the diagnosis of HCC remains suboptimal, as patients usually receive PC only at the very terminal phase of their disease, even when diagnosed early. Significant barriers to the uptake of palliative care in the treatment algorithm of hepatocellular carcinoma fall under four main themes: data limitations, disease, clinician, and patient factors. Barriers relating to data limitations mainly encapsulated the risk of bias inherent in published work in the field of PC. Clinician-reported barriers related to negative attitudes towards PC and a lack of time for PC discussions. Barriers related to the disease align with prognostic uncertainty due to the unpredictable course of HCC. Significantly, there exists a paucity of evidence exploring patient-perceived barriers to timely PC implementation in HCC. Given that patients are often the underrepresented stakeholder in the delivery of PC, future research should explore the patient perspective in adequately designed qualitative studies as the first step.