The Undertreatment of Gallbladder Cancer: Gaps in Seeking, Reaching, and Receiving Care

• Type of Material: Article
• Authors: Jessica M Keilson, Emory University; Shishir Maithel, Emory University
• Language: English
• Date: 2021-03-04
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © Society of Surgical Oncology 2021
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-021-09761-x
• Title of Journal or Parent Work: ANNALS OF SURGICAL ONCOLOGY
• Volume: 28
• Issue: 6
• Start Page: 2925
• End Page: 2927
• Keywords: Oncology; Life Sciences & Biomedicine; Surgery; Science & Technology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Gallbladder cancer (GBC) is an aggressive disease that carries a poor prognosis, with a 5-year overall survival rate of 5–13%. It is a rare malignancy with an estimated annual incidence of 0.4–1.4 cases per 100,000 population.1 There are a number of known risk factors associated with GBC, including chronic inflammatory states related to cholelithiasis and gallbladder polyps, as well as modifiable risk factors, such as obesity, poor diet, and chronic Salmonella or Helicobacter infections. GBC can be classified into two subgroups: incidental GBC and non-incidental, or per primum, GBC. Incidental GBC is diagnosed following routine cholecystectomy for presumed benign disease and accounts for the majority of cases, approximately 50–70%. Per primum GBC comprises the remaining 30–50% and typically presents at more advanced stages due to the lack of early clinical features. Papageorge and colleagues conducted a retrospective review of the National Cancer Database for patients who were diagnosed with incidental GBC between 2004 and 2015 to evaluate re-resection rates and survival outcomes.2 Within this study, only 7.6% of patients underwent re-resection, a trend not unique to this cohort of patients that highlights a nationwide breakdown in the management of GBC. The undertreatment of GBC is multifactorial. The authors outline two areas that represent major barriers to care: patient-specific variables, which include race and insurance status, and institutional barriers, such as institution-specific practices and type of facility. However, access to healthcare extends beyond patient-limiting and institution-specific factors and encompasses system-wide challenges.