Abstract：
Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of \"do-not-resuscitate\" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
摘要：
背景：姑息治疗解决了一系列需求，从症状管理到在整个疾病期间为肝细胞癌（HCC）患者及其家人提供支持。然而,肝癌姑息治疗的研究仍然有限，特别是在COVID-19大流行期间。这项研究调查了与HCC患者姑息治疗转诊相关的医疗保健利用。方法：这是一项回顾性横断面分析，使用2019年至2021年在年龄≥18岁的HCC患者中的国家住院患者样本（NIS）数据库进行。结果：在以HCC为主要诊断的35,220例住院患者中，18.7%接受了住院姑息治疗转诊。与姑息治疗转诊增加相关的因素包括年龄≥65岁，中西部地区,Charlson合并症指数（CCI）评分≥3，以及临终关怀，如出院导致死亡所反映的。没有观察到种族或保险差异。姑息治疗咨询与住院总费用较低相关（20,573美元vs26,035美元，<0.0001）。在姑息治疗转诊的患者中，“不复苏”的患病率也较高。结论：该研究提供了对大流行前和大流行期间姑息治疗利用的理解。高龄等因素,医院区域,潜在的合并症影响了转诊的可能性，没有明显的种族或保险差异。姑息治疗的参与也被证明可以提供具有成本效益的支持性治疗，同时降低医院成本。这些发现为优化姑息治疗与HCC管理的整合提供了宝贵的指导。
