Aldecoa Kim Abbegail Tan, Macaraeg Chef Stan L, Abougergi Marwan S, Krishnamoorthy Geetha, Arsene Camelia
Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA.
Wayne State University, Detroit, MI, USA.
Am J Hosp Palliat Care. 2025 Jun;42(6):571-579. doi: 10.1177/10499091241271371. Epub 2024 Aug 13.
Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
姑息治疗满足一系列需求，从症状管理到在整个病程中为肝细胞癌（HCC）患者及其家属提供支持。然而，关于HCC姑息治疗的研究仍然有限，尤其是在新冠疫情期间。本研究调查了HCC患者中与姑息治疗转诊相关的医疗服务利用情况。这是一项回顾性横断面分析，使用2019年至2021年国家住院样本（NIS）数据库，研究对象为年龄≥18岁的HCC患者。在以HCC作为主要诊断的35220次住院治疗中，18.7%的患者接受了住院姑息治疗转诊。与姑息治疗转诊增加相关的因素包括年龄≥65岁、中西部地区、查尔森合并症指数（CCI）评分≥3以及临终护理，这可通过导致死亡的出院情况反映出来。未观察到种族或保险方面的差异。姑息治疗会诊与较低的总住院费用相关（20573美元对26035美元，<0.0001）。在接受姑息治疗转诊的患者中，“不要复苏”状态的患病率也更高。该研究提供了对疫情前和疫情期间姑息治疗利用情况的了解。高龄、医院所在地区和潜在合并症等因素影响了转诊的可能性，未发现明显的种族或保险差异。姑息治疗的参与还被证明能提供具有成本效益的支持性护理，降低住院费用。这些发现为优化姑息治疗与HCC管理的整合提供了宝贵的指导。
