Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population

• Published in: Digestive diseases and sciences Vol. 63; no. 5; pp. 1173 - 1181
• Main Authors: Zou, Winnie Y., El-Serag, Hashem B., Sada, Yvonne H., Temple, Sarah L., Sansgiry, Shubhada, Kanwal, Fasiha, Davila, Jessica A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2018; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biochemistry; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Female; Gastroenterology; Hepatology; Hepatoma; Hospice care; Hospice Care - statistics & numerical data; Hospices (Terminal care); Humans; Kaplan-Meier Estimate; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Palliative care; Palliative Care - statistics & numerical data; Palliative treatment; Patient outcomes; Retrospective Studies; Transplant Surgery; Treatment Outcome; United States; Veterans Health; United States > US; Palliative care; Hepatocellular carcinoma; Hospice; Veteran
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-018-4989-4

Background Hospice provides integrative palliative care for advance-staged hepatocellular carcinoma (HCC) patients, but hospice utilization in HCC patients in the USA is not clearly understood. Aims We examined hospice use and subsequent clinical course in advance-staged HCC patients. Methods We conducted a retrospective study on a national, Veterans Affairs cohort with stage C or D HCC. We evaluated demographics, clinical factors, treatment, and clinical course in relation to hospice use. Results We identified 814 patients with advanced HCC, of whom 597 (73.3%) used hospice. Oncologist management consistently predicted hospice use, irrespective of HCC treatment [no treatment: OR 2.25 (1.18–4.3), treatment: OR 1.80 (1.10–2.95)]. Among patients who received HCC treatment, hospice users were less likely to have insurance beyond VA benefits (47.2 vs. 60.0%, p  = 0.01). Among patients without HCC treatment, hospice users were older (62.2 [17.2] vs. 60.2 [14.0] years, p  = 0.05), white (62.1 vs. 52.9%, p  = 0.01), resided in the Southern USA (39.5 vs. 31.8%, p  = 0.05), and had a performance score ≥ 3 (41.9 vs. 31.8%, p  = 0.01). The median time from hospice entry to death or end of study was 1.05 [2.96] months for stage C and 0.53 [1.18] months for stage D patients. Conclusions 26.7% advance-staged HCC patients never entered hospice, representing potential missed opportunities for improving end-of-life care. Age, race, location, performance, insurance, and managing specialty can predict hospice use. Differences in managing specialty and short-term hospice use suggest that interventions to optimize early palliative care are necessary.