Palliative care for hepatocellular carcinoma: Analysis of the National Cancer Data Base.

Abstract

390 Background: Palliative care is provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of symptomatic relief and improving quality of life. The present study sought to assess and compare the prevalence and efficacy of different palliative therapies for HCC from the National Cancer Database (NCDB). Methods: The NCDB, a retrospective national database that captures approximately 70% of all patients treated for cancer, was queried for patients with HCC who were deemed non-resectable from 1998-2011. Patients were stratified by receipt of palliative care. Descriptive analyses were performed. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival. Results: A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy, 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain therapy, while 209 (6.4%) received a combination of the previous 3 modalities. The median age was 61 (54-72), and 81.3% of the patients were males, and of Caucasian ancestry (72.5%). Difference in the Charlson Comorbidity Index (CCI) existed between the comparison groups (p< 0.001). On a multivariate hazards model, palliative radiotherapy was identified as a positive predictor of survival (Hazards Ratio (HR): 0.71 [95%CI:0.56-0.90]), while pain therapy was a negative predictor of survival (HR: 1.79 [95%CI: 1.43-2.25]). Stratifying by disease stage, palliative radiotherapy provided a significant survival benefit for patients with stage IV disease. Examining the RT cohort, most patients received external beam radiation (80%) and palliative radiation was most frequently delivered to the spine (35%) followed by the liver (19%). The survival benefit was more significant when the liver was targeted (OS: 3.7 months vs. 7.3 months, p= 0.03). Conclusions: Amongst the palliative therapies examined, radiotherapy appear to extend survival and should be considered for patients presenting with late stage HCC. Pain therapy alone acts as a negative predictor of survival and should not be considered as a sole intervention for patients with late stage disease.