Palliative Care Improves End-of-Life Care in Biliary Tract Cancer

Key takeaways

  • Palliative care for inoperable biliary tract cancer (BTC) reduces the use of aggressive chemotherapy at the end of life as well as the risk of death in the emergency department (ED) or intensive care unit (ICU).

  • Earlier referral to palliative care, however, does not improve overall survival.

  • Still, referrals to palliative care should not wait until systemic therapies have been exhausted.

Why This Matters

  • Most BTC patients present too late for curative surgery.

  • Referrals to palliative care usually come only after active treatments are exhausted.

  • The American Society of Clinical Oncology (ASCO) recommends that palliative care occur alongside active treatment.

  • The recent findings from researchers based in France support this recommendation.

Study Design

  • The study included 200 patients with locally advanced or metastatic BTC treated from 2013 to 2019 at six hospitals in eastern France.

  • The median age of the patients was 67.6 years, 61% were men, and 188 died (94%).

Key Results

  • Of the 200 patients included in the review, 44% received no palliative care,15% had palliative care within 3 months of their diagnosis, 10% had palliative care 3 to 6 months after diagnosis, and 32% had palliative care 6 months or more after.

  • Thirty-seven percent of patients in the no palliative care group had “useless” chemotherapy in their last month vs 10% to 30% of patients receiving palliative care.

  • Seventy-two percent of the no palliative care group died in the ICU and 8% died in the ED, vs 21% and 0%, respectively, of patients receiving palliative care.

  • Patients in the palliative care group were more likely to die in a palliative care unit.

  • Contrary to previous reports, earlier referrals to palliative care did not improve survival.

Limitations

  • It was a retrospective study with no randomization.

  • Survival outcomes were confounded because the hospitals generally waited until patients were close to death before referring to palliative care.

Disclosures

  • There was no funding for the work and the investigators did not report any conflicts of interest.

This is a summary of a preprint research report led by Margaux Miralles of the University Hospital Centre Nancy, provided to you by Medscape. This study has not yet been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is an MIT Knight Science Journalism fellow. Email: [email protected]

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