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Cirrhosis deaths increasing at home, in hospice

Inpatient cirrhosis-related deaths have decreased over the last decade while cirrhosis-related deaths at home or in hospice settings have increased, according to a recently published study. However, the number of cirrhosis-related deaths that occurred in hospice care was significantly lower compared with cancer-related deaths.

“Palliative and hospice care programs can decrease the burden of symptoms, reduce hospitalization and improve end-of-life care. There are limited data on the utilization of hospice in cirrhosis; a population that has received limited attention from the palliative care community,” Haider Altaii, MD, from the department of gastroenterology and hepatology at the Cleveland Clinic, Ohio, and colleagues wrote. “We aimed to identify trends and variations in both places of death and hospice utilization in cirrhosis.”

The researchers gathered data from the U.S. National Center for Health Statistics mortality records from 2003 to 2015 on 340,380 patients with cirrhosis-related deaths. Settings in which patients died included inpatient (49.1%), at home (24.1%), in nursing homes or long-term care (12.3%), in hospice (6.4%), outpatient or emergency department (3.1%), or other locations (5%).

Cirrhosis-related mortality rates increased from 10.3 per 100,000 in 2003 to 13.7 per 100,000 in 2015. From 2003 to 2015, cirrhosis-related deaths decreased in the inpatient setting (55.8% to 44.8%; P < .001) and nursing homes and long-term care units (12.8% to 11.8%; P < .001). In the same period, cirrhosis-related deaths increased at home (21.6% to 26.1%; P < .001) and in hospice care (0.2% to 11.6%; P < .001).

The researchers found, however, that use of hospice care remained lower in patients with cirrhosis (6.4%) compared with pancreatic (8.5%; P < .001), esophageal (7.6%; P < .001), colon (7.3%; P < .001), lung (7.1%; P < .001) and breast cancers (7.4%; P < 0.001).

Additionally, hospice deaths were more likely among white patients compared with black patients and other minorities (6.7% vs. 4.4% vs. 3.1%; P < .001), and among women compared with men (6.8% vs. 6.2%; P < .001).

“The reasons for low utilization of hospice among patients with cirrhosis remain speculative. The current prognostic scores, eg, MELD and Child Pugh, are not being employed in predicting hospice eligibility in cirrhosis,” the researchers concluded. “To increase hospice care utilization, it is necessary to develop strategies to define the needs and expectations of patients with cirrhosis. Furthermore, developing effective clinical scores to predict 6 months mortality in cirrhotic patients could help identify hospice eligibility and improve utilization.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.