S2466 Evolving End-of-Life Care Patterns for Hepatocellular Carcinoma in the United States: A 25-Year Analysis of Home and Hospice Deaths by Demographic, Regional, and Urbanization Factors

Introduction: Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and in the United States. Recently, 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. our study focus on the trends in the proportion of HCC decedents receiving home or hospice care over 25 years using nationwide surveillance data. 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 International Classification of Diseases, Tenth Revision 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. Overall population trends 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 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 of around 47.6%. Among the different racial and ethnic groups, non-Hispanic White decedents showed a notable increase from 44.57% to 58.04%, non-Hispanic Black decedents increased from 27.38% to 44.91%, and Hispanic decedents increased from 39.17% to 51.38%. Both woman and male patients experienced rising trends in home or hospice deaths, with women increasing from 41.67% to 54.48% and men 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 rural and urban areas, with rural settings increasing from 41.16% to 58.81% and urban settings from 40.04% to 59.86%. Conclusion: Findings show over the past 25 years, more HCC patients in the U.S. are receiving End of life care at home or in Hospice however significant disparities persist across demographics, regions, Urbanization levels. Targeted policies and improved access are needed to Ensure equitable and high quality care for all.