Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
Aliment Pharmacol Ther. 2018 Mar;47(5):680-688. doi: 10.1111/apt.14484. Epub 2018 Jan 3.
Few studies have assessed the impact of hospice care in patients with primary liver cancer.
To examine the determinants of hospice care and its effects on resource utilisation and survival among Medicare beneficiaries with primary liver cancer.
We utilised the Surveillance, Epidemiology and End result Registry (SEER) database from 2002 to 2009 for this cross-sectional study. A total of 3385 patients with primary liver cancer were included. We used logistic regression to discern variables associated with hospice and Cox proportional hazards models to evaluate one-year mortality risk.
Compared to patients who enrolled in a hospice, those patients who did not, were younger, non-White and sicker (P < .05 for all). Half of all patients with primary liver cancer died within six months of diagnosis, and one-year mortality was similar in both groups (P = .413). After adjusting for baseline characteristics [age at diagnosis, race, disease severity, tumour stage and treatment], shorter time to hospice care was associated with reduced mortality (HR per day: 0.99 [95% CI, 0.98-0.99]). Older age, decompensated cirrhosis and advanced tumours stage were associated with decreased time to hospice, while Asian/Pacific Islander race and history of radiosurgery were associated with increased time to hospice (all P < .05). Hospitalisations were more costly for those who never enrolled in a hospice compared to hospice enrollees (median $31 607 [$18 394-$54 254] vs $22 316 [$13 741-$36 170], P < .0001).
Hospice enrolment of patients with primary liver cancer provides survival and resource utilisation benefits. Some clinical and demographic factors may represent barriers to hospice enrolment. Further studies are needed to fully understand these barriers in patients with primary liver cancer.
很少有研究评估临终关怀对原发性肝癌患者的影响。
研究医疗保险原发性肝癌患者接受临终关怀的决定因素及其对资源利用和生存的影响。
本研究使用了 2002 年至 2009 年的监测、流行病学和最终结果登记处（SEER）数据库，共纳入 3385 例原发性肝癌患者。我们使用逻辑回归识别与临终关怀相关的变量，并使用 Cox 比例风险模型评估一年死亡率风险。
与参加临终关怀的患者相比，未参加临终关怀的患者年龄较小、非白人和病情较重（所有 P 值均<0.05）。一半的原发性肝癌患者在诊断后六个月内死亡，两组的一年死亡率相似（P=0.413）。在校正基线特征[诊断时年龄、种族、疾病严重程度、肿瘤分期和治疗]后，临终关怀时间越短，死亡率越低（每天风险比：0.99[95%可信区间，0.98-0.99]）。年龄较大、失代偿性肝硬化和晚期肿瘤分期与临终关怀时间缩短相关，而亚洲/太平洋岛民种族和放射外科史与临终关怀时间延长相关（所有 P 值均<0.05）。与参加临终关怀的患者相比，从未参加临终关怀的患者住院费用更高（中位数分别为 31607 美元[18394 美元-54254 美元]和 22316 美元[13741 美元-36170 美元]，P<0.0001）。
原发性肝癌患者参加临终关怀可带来生存和资源利用方面的获益。一些临床和人口统计学因素可能是参加临终关怀的障碍。需要进一步研究以充分了解原发性肝癌患者的这些障碍。
