Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients

Authors

Mark S. Obri, Henry Ford HealthFollow
Rami M. Youssef, Henry Ford HealthFollow
Spandana Alluri, Henry Ford HealthFollow
Krishna Vemulapalli, Henry Ford HealthFollow
Yervant Ichkhanian, Henry Ford HealthFollow
Erika Todter, Henry Ford HealthFollow
Michelle T. Jesse, Henry Ford HealthFollow
Reena Salgia, Henry Ford HealthFollow

Recommended Citation

Obri MS, Youssef RM, Alluri S, Vemulapalli K, Ichkhanian Y, Todter EN, Jesse MT, and Salgia R. Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients. Dig Dis Sci 2023.

Document Type

Article

Publication Date

8-1-2023

Publication Title

Digestive diseases and sciences

Abstract

BACKGROUND: Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC.

AIMS: We aim to report the relationship between demographics and EOL service referral.

METHODS: Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible.

RESULTS: Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors.

CONCLUSION: Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study.

Medical Subject Headings

Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Terminal Care; Hospice Care; Palliative Care; Retrospective Studies; Referral and Consultation

PubMed ID

37289417

ePublication

ePub ahead of print

Volume

68

Issue

8

First Page

3277

Last Page

3282