Center of Innovation, Effectiveness and Quality, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (MS152), Houston, TX, 77030, USA.
Sections of Health Services Research and Gastroenterology and Hepatology, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2018 May;63(5):1173-1181. doi: 10.1007/s10620-018-4989-4. Epub 2018 Mar 5.
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.
We examined hospice use and subsequent clinical course in advance-staged HCC patients.
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.
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.
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.
临终关怀为晚期肝细胞癌（HCC）患者提供综合姑息治疗，但美国 HCC 患者的临终关怀利用情况尚不清楚。
我们研究了晚期 HCC 患者的临终关怀使用情况及后续临床过程。
我们对一个国家退伍军人事务部队列进行了回顾性研究，队列中包含 C 期或 D 期 HCC 患者。我们评估了人口统计学、临床因素、治疗以及与临终关怀使用相关的临床过程。
我们确定了 814 例晚期 HCC 患者，其中 597 例（73.3%）使用了临终关怀。肿瘤医生的管理始终预测临终关怀的使用，而与 HCC 治疗无关[无治疗：OR 2.25（1.18-4.3）；治疗：OR 1.80（1.10-2.95）]。在接受 HCC 治疗的患者中，使用临终关怀的患者获得 VA 福利以外的保险的可能性较低（47.2%比 60.0%，p=0.01）。在未接受 HCC 治疗的患者中，使用临终关怀的患者年龄较大（62.2[17.2]岁比 60.2[14.0]岁，p=0.05），白人（62.1%比 52.9%，p=0.01），居住在美国南部（39.5%比 31.8%，p=0.05），且表现评分≥3（41.9%比 31.8%，p=0.01）。从进入临终关怀到死亡或研究结束的中位时间为 C 期患者 1.05[2.96]个月，D 期患者 0.53[1.18]个月。
26.7%的晚期 HCC 患者从未进入临终关怀，这代表改善临终关怀的潜在机会的错失。年龄、种族、位置、表现、保险和管理专科可以预测临终关怀的使用。管理专科和短期临终关怀使用的差异表明，需要进行干预以优化早期姑息治疗。
