A190 A PROSPECTIVE EVALUATION OF SYMPTOM BURDEN, OPIOID RISK, AND PERCEIVED BENEFITS OF NON-PHARMACOLOGICAL THERAPY IN CIRRHOSIS PATIENTS

Cirrhosis is associated with magnitude of symptoms leading to disability and poor quality of life. Although opioids are effective in many cases, opioid use has been associated with increased frequency of hepatic encephalopathy, cost related to hospital admission and longer hospital stay. In other chronic disease population including cancer, non-pharmacological therapies including yoga, group therapy, and mindfulness-based stress reduction have been shown to be efficacious for reducing pain, emotional distress, and fatigue. Patient interest, current use as well as perceived benefit and barriers for utilization of non-pharmacological therapies are unclear in cirrhosis patients. Within a population of patients with cirrhosis, we aimed to: 1) assess symptom burden; 2) risk of opioid dependency; 3) willingness to consider non-pharmacological therapy for symptom management. In a prospective study, we recruited 135 patients with chronic liver disease attending Cirrhosis Care Clinic at the University of Alberta Hospital and Royal Alexandra Hospital. Our inclusion criterion for the study was documented cirrhosis on imaging in individuals 18 years of age and older. We collected data on patient demographics, symptom burden using the Edmonton Symptoms Assessment Scale (ESAS-r), perceived overall wellbeing using EuroQuol Visual Analogue Scale (EQ-VAS), and risk of opioid dependency using Opioid Risk Tool Calculator. We also assessed patients’ familiarity with non-pharmacological therapy, willingness to try these therapies and any barriers preventing them from utilizing non-pharmacological modalities. 135 patients were recruited, mean age of 60 years with 62% being male patients, Child Pugh Class: A (58%), B (36%), and C (6%). Overall health status using EQ-VAS (EQ-VAS 0–100 Scale) was rated at 63.9 ± 22. Most commonly reported symptoms included: tiredness (52%), mood disorder (40%), drowsiness (36%), and pain (22%). In our study, 57% had moderate to severe opioid risk score, with higher scores being correlated with increased risk for opioid dependency and future abuse. Majority (85%) of patients were willing to learn about non-pharmacological approaches for their symptoms with the majority preferring an in person one-on-one delivery modality. The top three perceived barriers were expense, discomfort and concerns about privacy in a group setting. Despite the relatively well-compensated status of our cirrhosis cohort, symptom burden was significant and quality of life was low. In our study, we observed significant risk of opioid dependency. Patients have a high willingness to proceed with non-pharmacological therapy, with only few noted barriers. Therefore, more research is needed surrounding non-pharmacological therapeutic options in cirrhosis patients. None

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