Photo Credit: Mohammed Haneefa Nizamudeen
The following is a summary of “End-of-life in Hepatocellular Carcinoma: How Palliative Care and Social Factors Impact Care and Cost,” published in the October 2024 issue of Gastroenterology by Goble et al.
Palliative care, race, and socioeconomic status (SES) influence end-of-life care decisions, yet the roles in hepatocellular carcinoma (HCC) remain underexplored.
Researchers conducted a retrospective study assessing how palliative care consults, race, and SES impact invasive procedures in patients with HCC.
The study used the National Inpatient Sample (NIS) data (2016 to 2019), examining terminal and nonterminal hospitalized patients with HCC. Logistic regression analyzed associations between palliative care, race, income, and procedures, including do-not-resuscitate (DNR) orders, mechanical ventilation (MV), tracheostomy, and cardiopulmonary resuscitation (CPR) along with hospitalization costs.
The results showed 217,060 hospitalizations of patients with HCC, with 18.1% involving palliative care. The mean age was 65.0 years (SD = 11.3); 73.9% were male, and 55.5% were white. Terminal hospitalizations in Black patients were associated with more procedures, including CPR (aOR = 2.57, P<0.001), while Hispanic patients had higher rates of tracheostomy (aOR = 3.64, P=0.018) compared to white patients. Palliative care encounters reduced the use of procedures like MV (aOR = 0.47, P<0.001) and CPR (aOR = 0.24, P<0.001) during terminal hospitalizations, but not nonterminal ones. Income did not influence end-of-life procedures. Palliative care was linked to lower mean costs in both terminal ($23,608 vs $31,756, P<0.001) and nonterminal ($15,786 vs $19,914, P<0.001) hospitalizations.
They concluded that palliative care was associated with less aggressive end-of-life care and lower costs, while Black and Hispanic patients experienced more aggressive care at the end of life.
Source: journals.lww.com/jcge/abstract/9900/end_of_life_in_hepatocellular_carcinoma__how.366.aspx
