Impact of bundle care on quality of life and nutrition after transarterial chemoembolization

Abstract

BACKGROUND

The absence of standard postoperative protocols for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) may negatively affect health and quality of life (QoL). Bundle care is a multidisciplinary, evidence-based model that offers a structured approach. Yet, its effects on this population remain underexplored. The hypothesis in this study was that the implementation of the bundle care protocol can improve QoL and nutritional status after TACE.

AIM

To examine the effects of a multidisciplinary bundle care protocol on the QoL and nutritional status of post-TACE HCC patients.

METHODS

A tertiary hospital conducted a retrospective study on 80 HCC patients who underwent TACE from June 2023 to January 2025. They were included in the routine care group (control group; n = 40), routine care and bundle care group (intervention group; n = 40). The bundle care protocol included multidisciplinary coordination, dynamic assessments [Patient-Generated Subjective Global Assessment (PG-SGA), Hospital Anxiety and Depression Scale (HADS), Numerical Rating Scale], stepwise analgesia, stratified nutrition support, and intelligent follow-up with WeChat. The nutritional status (PG-SGA), psychological scores (HADS), post-embolization symptoms, and laboratory parameters were outcome measures. Independent t-tests, χ² tests and non-parametric tests were used to analyze data.

RESULTS

Post-intervention, the bundle care group showed significantly lower PG-SGA scores than the control group (1.86 ± 0.89 vs 4.46 ± 2.13, P < 0.001), lower anxiety (HADS- Anxiety: 0.36 ± 0.49 vs 4.25 ± 2.03, P < 0.001) and depression scores (HADS-Depression: 0.00 vs 5.00, P < 0.001). Albumin levels (38.33 ± 4.09 g/L vs 35.60 ± 4.87 g/L, P = 0.008) and body mass index (24.24 ± 2.45 vs 21.67 ± 2.63, P < 0.001) were significantly higher in the bundle care group. Nausea resolution was 97.5% in the bundle care group vs 87.5% in controls (P < 0.05).

CONCLUSION

In patients with HCC after TACE, bundle care can significantly improve nutritional status, psychological status, and symptom control to make a case for further clinical use.

Keywords: Bundle care; Transarterial chemoembolization; Hepatocellular carcinoma; Nutritional status; Quality of life

Core Tip: This study sought to assess a comprehensive bundle care protocol, an evidence-based multidisciplinary model integrating dynamic assessment, stratified nutrition and psychological support, and intelligent follow-up for hepatocellular carcinoma after transarterial chemoembolization (TACE). The bundle care was superior to routine care in improving nutritional statuses (lower Patient-Generated Subjective Global Assessment scores) as well as psychological distress (lower Hospital Anxiety and Depression Scale anxiety and depression scores). It also improved post-embolization syndrome which is a structured approach to facilitate post-TACE recovery.