title: Utilization and outcomes of palliative therapy for hepatocellular carcinoma: a population-based study in the United States.
abstract: OBJECTIVE
  To evaluate the utilization and determinants of receiving palliative treatment for hepatocellular carcinoma (HCC), and its effect on survival.
  
  
  BACKGROUND
  Palliative treatment for HCC, including transarterial chemoembolization (TACE) and systemic chemotherapy, is available for patients who do not receive potentially curative therapy. The utilization and outcomes of these therapies in clinical practice are unknown.
  
  
  METHODS
  We conducted a population-based cohort study using the Surveillance, Epidemiology, and End-Results Registry data linked to Medicare claims of HCC patients aged above 65 years diagnosed during 2000 to 2005 who did not receive liver transplant, resection, or ablation. The proportions of patients who received TACE or systemic chemotherapy were calculated by tumor stage, liver disease status, and non-HCC comorbidity. Determinants of receiving palliative therapy were examined in logistic regression models and propensity scores were calculated. Cox proportional hazards models were used to evaluate mortality risk.
  
  
  RESULTS
  We identified 3163 HCC patients (median age, 75 y; 67% men) who did not receive potentially curative treatment. Approximately 12.5% of patients received TACE and 11.0% received chemotherapy. In patients with early or intermediate stage HCC, no liver decompensation, and little or no comorbidity, only 22.8% received TACE and 13.8% received chemotherapy. Median survival was significantly higher among patients who received TACE (14.0 mo) compared with who received chemotherapy (5.0 mo) or no therapy (2.0 mo). A significant reduction in overall mortality was observed for TACE (54%) and chemotherapy (33%).
  
  
  CONCLUSIONS
  Utilization of palliative treatment for HCC is low, which could not be explained by clinical features. However, misclassification could have occurred due to the data source. Receipt of TACE or systemic chemotherapy was associated with a reduction in mortality.
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA. jdavila@bcm.tmc.edu
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Duan
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010166:Palliative Care / Q000379:methods*; D011159:Population Surveillance; D057216:Propensity Score; D016016:Proportional Hazards Models; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents