Palliative Care Referral Practices and Impact on Survival of Patients Diagnosed With Advanced Hepatocellular...

Palliative care (PC) utilisation is poorly described for patients with advanced hepatocellular carcinoma (HCC), whereas the benefits of PC have been described in a large range of clinical burdens, including prognosis. We aimed to describe the end-of-life (EOL) care pathway and to assess the impact of PC referral on survival after systemic treatment discontinuation in patients with advanced HCC.

EOL care-HCC is a retrospective multicentre study conducted among deceased HCC patients who had received systemic treatment for HCC between January 1, 2016, and December 31, 2021. Baseline characteristics, timing of PC referral and the EOL care pathway after the last treatment administration (LTA) were collected. The primary outcome was time from LTA to death.

Among the 224 patients for which the palliative care team (PCT) contact status was known, 49.1% (n = 110) met a PCT and 27.2% (n = 61) met a PCT before the LTA. The median overall survival after LTA was 7.00 weeks (95% confidence interval 5.56-8.26). There was no survival benefit in patients who had contact with PCT (p = 0.57), but the median overall survival after LTA was significantly longer if PC referral occurred before the LTA (9.13 vs. 5.34 weeks, p = 0.014). In multivariate analysis, no difference was observed between both two subgroups.

Nearly half of patients with advanced HCC met a PCT, without any observed survival benefit. However, early PC referral, before systemic treatment discontinuation, seemed associated with better survival after LTA. PC remains underused and delayed in the advanced HCC care pathway.