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End‐Of‐Life Outcomes and Healthcare Utilization for Patients With Hepatocellular Carcinoma Who Received Immune Checkpoint Inhibition
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End‐Of‐Life Outcomes and Healthcare Utilization for Patients With Hepatocellular Carcinoma Who Received Immune Checkpoint Inhibition
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Journal Article
End‐Of‐Life Outcomes and Healthcare Utilization for Patients With Hepatocellular Carcinoma Who Received Immune Checkpoint Inhibition
2025
Overview
Introduction Immune checkpoint inhibitors (ICI) have revolutionized treatment for advanced hepatocellular carcinoma (HCC). However, end‐of‐life (EOL) outcomes and healthcare utilization patterns prior to death for patients who receive ICI compared to non‐ICI as their last therapy are unknown. Methods Patients with advanced HCC evaluated from January 1, 2020, and who died by March 29, 2024, were included for analysis. Primary EOL outcomes include: advance directives, goals of care conversations, location of death, palliative care referral, hospice referral, and hospice duration. Secondary healthcare utilization outcomes include systemic therapy receipt, emergency department visits, hospitalizations, and intensive care unit admissions within 14, 30, and 90 days of death. Outcomes were stratified by ICI or non‐ICI as the last therapy received, and p values were derived using Pearson's chi‐square test for equality of proportions. Results We identified 71 patients for our retrospective cohort: mean age 64.1 years; 70.8% male; Child Pugh (CP) status at last treatment: 51.1% CPA, 40.0% CPB, 8.9% CPC. No differences in EOL outcomes were detected between groups; median days enrolled in hospice did not differ (24.5 days [non‐ICI] vs. 10 days [ICI]; p = 0.39). Yet, a higher proportion of patients who received ICI as the last therapy had increased healthcare utilization across secondary outcomes. Conclusions Patients with advanced HCC receiving ICI as their last treatment before death, compared to those receiving non‐ICI, had similar EOL outcomes but higher healthcare utilization. Further investigation into risk stratification to predict high healthcare utilizers could guide decision‐making around the ongoing use of ICI near the EOL. Patients with hepatocellular carcinoma received more immune checkpoint inhibitors (ICI) closer to death than patients treated with non‐ICI therapy. Patients who received ICI as their last therapy had higher healthcare utilization at the end of life.
Publisher
John Wiley & Sons, Inc,Wiley
Subject
/ Aged
/ Carcinoma, Hepatocellular - drug therapy
/ Carcinoma, Hepatocellular - mortality
/ Death
/ Female
/ Hospice Care - statistics & numerical data
/ Humans
/ Immune checkpoint inhibitors
/ Immune Checkpoint Inhibitors - therapeutic use
/ Liver Neoplasms - drug therapy
/ Male
/ Melanoma
/ Palliative Care - statistics & numerical data
/ Patient Acceptance of Health Care - statistics & numerical data
/ Patients
