End-of-life care preferences in patients with gallbladder cancer: Shifting patterns and disparities over two decades

Newswise — Background: Gallbladder cancer (GBC) is an aggressive malignancy with a combined survival rate of 20%. Some studies have reported less than 10 percent utilization of palliative care services in this population. Place of Death (PoD) is an important determinant of patient and caregiver preference and cost of caregiving at the end of life (EOL). We evaluate trends in PoD for patients with GBC in the U.S. from 2003 to 2020 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database.

Methods: We analyzed data using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to GBC was pooled using the International Classification of Diseases-10th revision code as C23, including all Gallbladder Cancers. The inclusion criteria included patients aged > 18. PoD was defined as deaths at home or hospice versus medical facilities. Annual percentage change (APC), average annual percentage change (AAPC), and joint point analysis were done using the Joinpoint Regression Program, Version 5.0.2.

Results: The analysis demonstrated a total of 37,576 deaths from GBC. Fifty-eight percent of deaths (21,805) were at home or hospice; AAPC: 3.23%, CI 1.4 to 5.0 (p = 0.0002). A significantly increasing trend of dying at medical facilities was seen amongst African Americans (AA); AAPC: 1.06%, CI 0.02 to 2.10, (p = 0.04), while Whites had a significant increase in the utilization of home or hospice-based care; AAPC: 2.7%, CI 2.1 to 3.2; p < 0.0001). On age stratification, there was a significant decline in using medical facilities as PoD for the > 65 yrs cohort; AAPC: -2.65% CI -3.1 to -2.1 (p < 0.0001). In contrast, the middle age group (45-64 yrs) had a trend towards decline, which was not significant in the usage of medical facilities as PoD with AAPC: -0.42% CI -1.24 to -0.4 (p = 0.29).

Conclusions: To our knowledge, this is the first study providing valuable insights into the evolving PoD preferences among GBC patients in the U.S. The racial disparities highlight the need for targeted interventions and culturally sensitive end-of-life care for different demographic groups. The age-related trends underscore the importance of tailoring end-of-life care strategies to specific age cohorts. The findings emphasize the importance of policies promoting and supporting home and hospice-based care for GBC patients. Targeted efforts are warranted to address disparities in PoD preferences among racial and age groups.