title: Hospice offers more palliative care but costs less than usual care for terminal geriatric hepatocellular carcinoma patients: a nationwide study.
abstract: BACKGROUND
  Hospice care is important for patients with terminal hepatocellular carcinoma (HCC), especially in endemic areas of viral hepatitis. Differences between hospice care and usual care for geriatric HCC inpatients have not yet been explored in a nationwide survey.
  
  
  OBJECTIVE
  The study's purpose was to analyze differences between hospice care and usual care for geriatric HCC inpatients in a nationwide survey.
  
  
  METHODS
  This nationwide, population-based study used data obtained from the Taiwan National Health Insurance Database. Patients with terminal HCC who were ≥65 years old and received their end-of-life care in the hospital between January 2001 and December 2004 were recruited. The comparison group was selected by propensity score matching from patients receiving usual care in acute wards.
  
  
  RESULTS
  We enrolled 729 terminal HCC patients receiving inpatient hospice care and 729 matched controls selected from 2482 HCC patients receiving usual care. Hospice care patients were treated mainly by family medicine doctors (36%) and oncologists (26%), while usual care patients were treated mainly by gastroenterologists (60.2%). The natural opium alkaloids were used more in the hospice care group than in the usual care group (72.7% versus 25.5%, P<0.001), whereas the length of stay (8±7.7 days versus 14.1±14.3 days, P<0.001), aggressive procedures (all P<0.005), and medical expenses (all P<0.001) were significantly less in the hospice care group.
  
  
  CONCLUSIONS
  HCC patients in hospice wards received more narcotic palliative care, underwent fewer aggressive procedures, and incurred lower costs than those in acute wards. Hospice care should be promoted as a viable option for terminally ill, elderly HCC patients.
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hsiao-Ting
authors.initials: HT
authors.lastname: Chang
authors.forename: I-Hsuan
authors.initials: IH
authors.lastname: Hwang
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Wang-Hsuan
authors.initials: WH
authors.lastname: Yang
authors.forename: Chung-Pin
authors.initials: CP
authors.lastname: Li
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D003365:Costs and Cost Analysis; D005260:Female; D019538:Health Care Surveys; D017051:Hospice Care / Q000191:economics* / Q000379:methods / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008020:Life Support Care / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D010166:Palliative Care / Q000191:economics* / Q000379:methods / Q000592:standards; D057216:Propensity Score; D059039:Standard of Care; D013624:Taiwan / Q000453:epidemiology; D019452:Terminally Ill / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid