Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Palliat Med. 2013 Jul;16(7):780-5. doi: 10.1089/jpm.2012.0482. Epub 2013 May 13.
Hospice care is important for patients with terminal hepatocellular carcinoma (HCC), especially in endemic areas of viral hepatitis. Differences between hospice care and usual care for geriatric HCC inpatients have not yet been explored in a nationwide survey.
The study's purpose was to analyze differences between hospice care and usual care for geriatric HCC inpatients in a nationwide survey.
This nationwide, population-based study used data obtained from the Taiwan National Health Insurance Database. Patients with terminal HCC who were ≥65 years old and received their end-of-life care in the hospital between January 2001 and December 2004 were recruited. The comparison group was selected by propensity score matching from patients receiving usual care in acute wards.
We enrolled 729 terminal HCC patients receiving inpatient hospice care and 729 matched controls selected from 2482 HCC patients receiving usual care. Hospice care patients were treated mainly by family medicine doctors (36%) and oncologists (26%), while usual care patients were treated mainly by gastroenterologists (60.2%). The natural opium alkaloids were used more in the hospice care group than in the usual care group (72.7% versus 25.5%, P<0.001), whereas the length of stay (8±7.7 days versus 14.1±14.3 days, P<0.001), aggressive procedures (all P<0.005), and medical expenses (all P<0.001) were significantly less in the hospice care group.
HCC patients in hospice wards received more narcotic palliative care, underwent fewer aggressive procedures, and incurred lower costs than those in acute wards. Hospice care should be promoted as a viable option for terminally ill, elderly HCC patients.
临终关怀对终末期肝细胞癌（HCC）患者非常重要，尤其是在病毒性肝炎流行地区。在全国范围内的调查中，尚未探讨姑息治疗与老年 HCC 住院患者常规治疗之间的差异。
本研究旨在分析全国范围内姑息治疗与老年 HCC 住院患者常规治疗之间的差异。
本项全国性、基于人群的研究使用了从台湾全民健康保险数据库中获得的数据。纳入年龄≥65 岁、2001 年 1 月至 2004 年 12 月期间在医院接受终末期 HCC 治疗的患者。比较组通过倾向评分匹配选择了在急性病房接受常规治疗的患者。
共纳入 729 例接受住院姑息治疗的终末期 HCC 患者和 729 例从 2482 例接受常规治疗的 HCC 患者中匹配的对照组。姑息治疗组的治疗医生主要是家庭医生（36%）和肿瘤学家（26%），而常规治疗组的治疗医生主要是胃肠病学家（60.2%）。姑息治疗组使用天然阿片生物碱的比例高于常规治疗组（72.7%比 25.5%，P<0.001），而姑息治疗组的住院时间（8±7.7 天比 14.1±14.3 天，P<0.001）、侵袭性操作（均 P<0.005）和医疗费用（均 P<0.001）明显低于常规治疗组。
姑息治疗病房的 HCC 患者接受了更多的阿片类药物姑息治疗，接受的侵袭性操作更少，费用更低。姑息治疗应作为终末期老年 HCC 患者的可行选择加以推广。
