Abstract 60P
Background
Little is known about epidemiology of iCCA in daily practice. We aimed to estimate from real-life data the incidence of iCCA in France and to describe the healthcare pathways of these patients (pts).
Methods
A retrospective analysis was carried out using the nationwide prospective French PMSI database. All pts with new diagnosis of "carcinoma of the intrahepatic bile duct” who had a 1st hospital stay (S1) in Medicine, Surgery and Obstetrics departments (MSO) between 2014-2015 with a 2-year follow-up were included. Data related to the S1 in MSO and on all subsequent stays in MSO, Aftercare and Rehabilitation or Home Hospitalizations were analyzed.
Results
A total of 3,650 new iCCA cases were identified. At S1 (admission via emergency room [ER] in 28%), median age of pts was 73y, 57% were male and 35% had metastases. Jaundice/anemia/ascites/cholangitis were reported in 17%/16%/12%/7%, respectively. Pts care at S1 was mainly provided in general hospitals (CHG, 60%), rather than university hospitals (CHU, 15%), private (20%) or cancer centers (CLCC, 6%). 896 (24%) pts died during S1: they were more often hospitalized via ER (48% vs 23%), metastatic (52% vs 35%) and symptomatic. Subsequent stays were identified for 2,507 pts (69%). Most pts were managed in CHG during their follow-up (70% vs 20% in CHU and 12% in CLCC). Centers were classified as low (≤5 pts treated over the study period, 68%), intermediate (5-20 pts, 26%) or high volume (>20 pts, 6%). 47% of the high-volume centers were CHU/CLCC. Three healthcare pathways were defined: surgery (n=519; 14%), chemotherapy (CT; n=812; 22%) and best supportive care (BSC; n=2,319; 63%). CT, surgery and BSC were most frequently performed in CLCC, CHU and CHG, respectively. Pts who received CT were younger, less frequently hospitalized via ER and less symptomatic at S1. A palliative care code was associated with S1 in 25% of pts and with a subsequent stay in 60%.
Conclusions
This real-life medico-administrative study reveals a higher incidence of iCCA in France than that previously reported and highlights the severity of this disease, the central role of CHG in the management of pts and the expertise of CHU and CLCC for surgery and CT, respectively.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Incyte Biosciences.
Disclosure
C. Neuzillet: Honoraria (self), Advisory/Consultancy: Servier; Honoraria (self), Advisory/Consultancy, Clinical trial: AstraZeneca; Honoraria (self), Advisory/Consultancy, Clinical trial: Bristol-Myers Squibb; Honoraria (self), Advisory/Consultancy: Amgen; Honoraria (self), Advisory/Consultancy: Merck; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: Novartis; Honoraria (self), Advisory/Consultancy: Incyte; Honoraria (self), Advisory/Consultancy: Nutricia; Honoraria (self), Advisory/Consultancy: Baxter; Honoraria (self), Advisory/Consultancy: Fresenius Kabi; Travel/Accommodation/Expenses, Clinical trial: OSE Immunotherapeutics; Research grant/Funding (institution): Roche. C. EMERY: Full/Part-time employment: CEMKA. C. TEISSIER: Full/Part-time employment: CEMKA. S. BOUÉE: Full/Part-time employment: CEMKA. A. LIÈVRE: Honoraria (self), Advisory/Consultancy: AAA; Honoraria (self), Advisory/Consultancy: Amgen; Honoraria (self), Advisory/Consultancy: Bayer; Honoraria (self): BMS; Honoraria (self): Celgene; Honoraria (self): HalioDX; Advisory/Consultancy, Research grant/Funding (institution): Incyte; Honoraria (self), Advisory/Consultancy: Ipsen; Honoraria (self): Lilly; Honoraria (self), Advisory/Consultancy: Merck; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Novartis; Honoraria (self), Advisory/Consultancy: Pierre Fabre; Honoraria (self): Roche; Honoraria (self), Advisory/Consultancy: Sandoz; Honoraria (self), Advisory/Consultancy: Servier; Research grant/Funding (institution): Integragen.