How should I manage a patient with confirmed cholangiocarcinoma in terms of palliative care options?

Recommended palliative care options for a patient with confirmed cholangiocarcinoma focus on symptom management, improving quality of life, and addressing complications related to biliary obstruction and tumor burden.

Initial palliative management often involves biliary drainage to relieve obstructive jaundice, which can be achieved via endoscopic stenting or percutaneous drainage depending on anatomical feasibility and local expertise. This intervention helps alleviate symptoms such as pruritus and cholangitis, improving patient comfort and potentially enabling further palliative treatments (Tang et al., 2017; Wheless et al., 2024).

Symptom control should include effective pain management using opioids tailored to the severity of pain, alongside non-pharmacological approaches. Management of other distressing symptoms such as nausea, vomiting, and breathlessness should be multidisciplinary, incorporating pharmacological and supportive care strategies (NG31; Wheless et al., 2024).

For patients with locally advanced or metastatic disease, palliative chemotherapy may be considered to slow disease progression and improve symptoms, but the decision must balance potential benefits against side effects and patient preferences (Wheless et al., 2024; Elias et al., 2024).

Radiotherapy can be used palliatively to control local tumor growth and relieve symptoms such as pain or biliary obstruction when stenting is not feasible or as adjunctive therapy (Elias et al., 2024).

Referral to specialist palliative care teams is recommended early to provide holistic support, including psychosocial care, advance care planning, and management of complex symptoms, ensuring care aligns with patient goals and improves quality of life (NG31; Wheless et al., 2024).

Overall, the palliative approach for cholangiocarcinoma integrates interventional procedures for symptom relief, pharmacological symptom control, and multidisciplinary supportive care tailored to individual patient needs and prognosis.