Margaux Miralles , Marie Muller , Christophe Borg , Sylvain Manfredi , Anne Minello , Olivier Bouché , Marlène Tambou , Didier Mutter , Pascale Chiappa , Jean-Emmanuel Kurtz , Amandine Luc , Cédric Baumann and Anthony Lopez
Background: Most of patient with Biliary Tract Cancer (BTC) has not access to surgery because of Advanced/metastatic disease at diagnosis (aBTC). They receive palliative chemotherapy and/or Palliative Care (PC). We studied if early palliative care referral might influence Overall Survival (OS) and the aggressiveness of end-of-life care.
Participants: We conducted a retrospective multicentric cohort study in patients with non-curative BTC, diagnosed between 2013 and 2019 in 6 hospitals of Eastern France. PC was defined a specialist-delivered palliative care encounter.
Results: 200 patients with aBTC were included. 87 (44%) never received PC, 30 (15%) had very early PC (<3 months after aBTC diagnosis), 20 (10%) had an early PC (3-6 months), and 63 (32%) had late PC (>6 months). The median time between referral and death was 0.9 to 1.3 months. OS were 12.4 months (no PC), 3.0 months (PC<3 m), 6.4 months (PC 3-6 m), 16 months (PC>6 m). There was no evidence for survival improvement with early PC. PC tended to reduce chemotherapy near death (37% without PC, 30% with PC<3m, 11% with PC 3-6m, 10% with PC>6m), visits in emergency department (ED) during final month (respectively: 36%, 20 %, 15%, and 7%), intensive care unit hospitalizations (ICU) near death (13%, 0%, 0%, 2%). Place of death seemed to be positively impacted by PC (conventional acute unit, respectively: 73%, 21%, 21%, 25% and ICU or ED: 8%, 0%, 5%, 2%).
Conclusion: Referral to PC remains too late in the support of patients with aBTC. Our practice should evolve: all patients with aBTC should be referred to early PC in palliative care unit after diagnosis to improve the management of end-of-life, symptoms, and family needs.
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