Deaths From Hepatocellular Carcinoma Are More Likely to Occur in Medical Facilities Than Deaths From Other Cancers: 2003–2018

Katie Truitt; Sadiya S. Khan; Dyanna L. Gregory; Sarah Chuzi; Lisa B. VanWagner

Disclosures

Liver International. 2021;41(7):1489-1493. 

In This Article

Abstract and Introduction

Abstract

Place of death is a key indicator of quality of end-of-life care, and most people with a terminal diagnosis prefer to die at home. Home has surpassed the hospital as the most common location of all-cause and total cancer-related deaths in the United States. However, trends in place of death due to hepatocellular carcinoma (HCC), which is uniquely comanaged by hepatologists and oncologists, have not been described. We analysed US death certificate data from 2003 to 2018 for the proportion of deaths over time at medical facilities, nursing facilities, hospice facilities and home, for HCC and non-HCC cancer. The proportion of deaths increased from 0.6% to 15.2% in hospice facilities (P trend < 0.0001) but did not change at home. In multivariable analysis, persons with HCC were more likely than persons with non-HCC cancer to die in medical facilities, while persons with HCC were less likely to die at home.

Introduction

Place of death is a key indicator of quality of end-of-life care and most people with a terminal diagnosis prefer to receive end-of-life care at home.[1] Further, home deaths are associated with significantly lower psychosocial and financial caregiver burden.[2] Recently, home has surpassed the hospital as the most common location of all-cause and cancer-related deaths in the United States for the first time since the early 20th century.[3–5] However, trends in place of death from hepatocellular carcinoma (HCC) have not been described. HCC, unlike other solid tumours, is often diagnosed by hepatologists and treated by both hepatologists and oncologists, which may lead to differences in end-of-life care and place of death. We therefore sought to determine the distribution of and trends in place of death due to HCC compared with all other cancers.

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