Product information and disease description Place of product in therapy Disease description

Long-term morbidity

6 evidence topics · 5 sources

Summary: cumulative morbidity in advanced and second-line disease

Long-term morbidity in advanced biliary tract cancer is dominated by recurrent biliary obstruction and its management, by infection, and by functional decline after progression on first-line therapy. Active symptom control in the second-line setting is defined to include biliary drainage, antibiotics, analgesia, steroids, anti-emetics, palliative radiotherapy, and transfusion of blood products. In a single-centre series of 171 participants who received a palliative biliary stent, complications occurred in 91 (53%) and cholangitis was the most frequent, in 48 (53%) of those with complications; median survival was 75.5 days. In a United States claims cohort, 69.5% of participants had an all-cause inpatient hospitalization and 65.6% a biliary-tract-cancer-related hospitalization, with a mean stay of 7 days per visit and the largest share of inpatient visits occurring during third-line therapy. Rapid decline in performance status after first-line progression limits how many participants can be treated at all.

Long-term morbidity: recurrent biliary obstruction and the content of active symptom control

“ASC consisted of early identification and treatment of biliary-related complications and cancer-related symptom management; it could include (and was not limited to) the following as per requirements of individual patients: biliary drainage, antibiotics, analgesia, steroids, anti-emetics, other palliative treatment for symptom control, palliative radiotherapy (eg, for painful bone metastases), and transfusion of blood products.” (opens the source at this quote in a new tab)

“In patients with biliary obstruction, biliary drainage and subsequent treatment should be carried out; when endoscopic access is not possible, percutaneous transhepatic drainage is recommended [IV, A].” (opens the source at this quote in a new tab)

Long-term morbidity: complications of palliative biliary drainage

“Insertion of a biliary stent was performed in 171 patients. The most common diagnoses were gastric and colorectal cancers, each with 42 (24%), followed by pancreatic (34 (20%)) and biliary tract cancer (25 (14%)). Most stents (155 (91%)) were placed percutaneously. Complications were seen in 91 (53%) patients and the most common was cholangitis in 48 (53%) patients, and the median survival was 75.5 days (3-1246).” (opens the source at this quote in a new tab)
“The 30-day mortality was 27%. Some patients had relatively long survivals: 12 (7%) lived more than 1 year, 2 (1%) more than 2 years, and one more than 3 years.” (opens the source at this quote in a new tab)
“The type of complications described in this study need admission to a health service for treatment of infections, insertion of another stent or other procedure, and all this have a negative impact in the quality of life of patients with a very limited life expectancy.” (opens the source at this quote in a new tab)

Long-term morbidity: hospitalization burden rises with each line of therapy

“Overall, 69.5% of patients had all-cause inpatient hospitalizations and 65.6% patients had BTC-related inpatient hospitalizations during the follow-up period. Patients stayed in hospital for a mean period of 7 days per visit. Both all-cause and BTC-related inpatient hospitalizations increased in number as the LOT advanced, with most inpatient visits (55.1%) reported during 3LOT among all LOTs (Table 3).” (opens the source at this quote in a new tab)

Long-term morbidity: functional decline after progression on first-line therapy

“Patients with advanced biliary tract cancer often experience a rapid decline in performance status following progression on first-line chemotherapy, and only 15–25% receive second-line therapy.” (opens the source at this quote in a new tab)

“In the current study, 46.0% of patients received 2LOT, which could be due to a number of reasons such as potentially high morbidity in patients who progress after 1LOT, poor performance status, or lack of effective treatment options in 2LOT.” (opens the source at this quote in a new tab)

Long-term morbidity: recurrence after curative-intent resection

“Tumour resection is still the only potentially curative option for these patients, although only a small percentage of patients are eligible and the percentage recurrence is high.” (opens the source at this quote in a new tab)