End-Of-Life Outcomes and Healthcare Utilization for Patients With Hepatocellular Carcinoma Who Received Immune Checkpoint Inhibition.

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.