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Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population

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Abstract

Background

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.

Aims

We examined hospice use and subsequent clinical course in advance-staged HCC patients.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

This project was supported in part by the National Cancer Institute (R01 CA160738; PI, J. Davila), and the facilities and resources Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Author information

Authors and Affiliations

  1. 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

    Winnie Y. Zou, Hashem B. El-Serag, Yvonne H. Sada, Sarah L. Temple, Shubhada Sansgiry, Fasiha Kanwal & Jessica A. Davila

  2. 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

    Winnie Y. Zou, Hashem B. El-Serag, Yvonne H. Sada, Fasiha Kanwal & Jessica A. Davila

  3. South Central Mental Illness Research, Education and Clinical Centers, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA

    Shubhada Sansgiry

Authors
  1. Winnie Y. Zou
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  2. Hashem B. El-Serag
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  3. Yvonne H. Sada
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  4. Sarah L. Temple
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  5. Shubhada Sansgiry
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  6. Fasiha Kanwal
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  7. Jessica A. Davila
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Contributions

WYZ designed the study, acquired, analyzed, and interpreted the data and drafted the manuscript. HBE and JAD conceptualized and designed the study and critically revised the manuscript. YHS, SLT, and SS acquired, analyzed, and interpreted the data. FK analyzed and interpreted the data and provided critical revision for the manuscript.

Corresponding author

Correspondence to Jessica A. Davila.

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The authors declare no conflicts of interest.

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Supplemental Figure 1

Kaplan–Meier survival analysis of late-stage HCC patients (BCLC stages C and D) grouped by hospice use and treatment status (PPTX 55 kb)

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Zou, W.Y., El-Serag, H.B., Sada, Y.H. et al. Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population. Dig Dis Sci 63, 1173–1181 (2018). https://doi.org/10.1007/s10620-018-4989-4

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  • DOI: https://doi.org/10.1007/s10620-018-4989-4

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