Hepatocellular carcinoma and end-of-life care.

Abstract

278 Background: Patients with hepatocellular carcinoma (HCC) usually present with incurable tumors and advanced underlying liver disease. Although guidelines exist to assess the quality of end of life (EOL) care for cancer patients, little is known about EOL care for HCC patients. Due to the complexity and multidisciplinary nature of the disease, we hypothesized that EOL care for HCC patients differs from that delivered to other cancer patients and may be heterogenous based on patient characteristics and primary clinician specialty. Methods: We assessed EOL HCC care through medical chart review of 188 consecutive HCC patients treated at an academic tertiary care hospital who died between 2007 and 2013. Based on available data, EOL care and documentation was assessed per published guidelines. Patient, HCC and liver disease characteristics, cancer treatments, symptom burden, and EOL care and documentation was compared by provider specialty. The odds of receiving aggressive EOL care by provider specialty, patient characteristics, and documentation measures were calculated. Using data from the Dartmouth Atlas Project, we compared results with EOL data for cancer patients overall at our institution and nationally during a similar time frame. Results: Fewer HCC patients enrolled in hospice compared with cancer patients overall at our institution, and nationally (36%, 49% and 55%, respectively). In addition, HCC patients spent fewer days on hospice, spent more time in the hospital, and experienced more (and longer) intensive care unit admissions. Compared to those primarily cared for by other specialties, HCC patients seen by an oncologist were more likely to have goals of care (GOC) documentation and to enroll in hospice. Patients never seen by an oncologist were more likely to have a psychiatric illness. English as a non-primary language and code status documentation were among factors associated with more aggressive EOL care. Conclusions: At our institution, EOL care for HCC patients is more aggressive compared to cancer patients overall and nationally. The subset of HCC patients seen by oncology were more likely to meet EOL quality guidelines (GOC documentation and hospice enrollment). A better understanding of EOL practices for HCC may impact multidisciplinary care.