Evolving end-of-life care patterns for hepatocellular carcinoma in the United States: A 25-year national analysis of disparities in home and hospice utilization.

[BACKGROUND AND AIMS] Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and in the United States. In recent decades, there has been a growing emphasis on end-of-life care delivered in home or hospice settings, yet detailed contemporary insights into how these patterns differ by sex, race/ethnicity, region, and urbanization remain sparse. This study aimed to characterize the trends in the proportion of HCC descendants receiving home or hospice care over a 25-year period, using data derived from the CDC WONDER database.

[METHODS] Data for HCC-related mortality were obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database by ICD-10 code (C22.0), covering the years from 1999 to 2024. The analysis focused on the proportion of home or hospice deaths relative to the total number of HCC-related deaths. Trends were examined for the overall population as well as stratified by race/ethnicity, sex, census region, and urbanization. Trend analysis was conducted using Joinpoint 5.30 to identify significant changes in the temporal patterns.

[RESULTS] The overall proportion of patients with HCC who died at home or in hospice increased steadily over the study period, rising from approximately 40.19% in 1999 to 54.67% in the most recent year, with an overall aggregate proportion around 47.6%. Among the different racial and ethnic groups, Non-Hispanic White decedents showed a notable increase from 44.57% to 58.04%, while Non-Hispanic Black decedents increased from 27.38% to 44.91%, and Hispanic decedents from 39.17% to 51.38%. Both female and male patients experienced rising trends in home or hospice deaths, with females increasing from 41.67% to 54.48% and males from 39.64% to 54.73%. Regional variations were evident, with the South consistently reporting the highest proportions of home or hospice deaths, starting at 42.71% in 1999 and reaching 58.38% in the latest data, while the Northeast exhibited comparatively lower rates. A similar upward trend between 1999 and 2020 was observed in both rural and urban areas, with rural settings increasing from 41.16% to 58.81% and urban settings from 40.04% to 59.86%.

[CONCLUSION] In conclusion, our study highlights both obvious progress and persistent disparities in end-of-life care in HCC patients in the US. Significant disparities do exist between racial/ethnic groupings and geographical areas, despite a significant increase in home/hospice utilization. Multiple interventions which intend to remove barriers to healthcare access, enhance cultural competence palliative care administration, and apply policy reforms to support concurrent palliative and disease-modifying therapies will be necessary to achieve health equity. Ensuring that all patients have fair access to high-quality end-of-life care should be a top priority for physicians, researchers, and policymakers as the prevalence of HCC keeps increasing.