S73 Effect of Substance Abuse on Cholangiocarcinoma Outcomes and Screening in a Large Urban Safety-Net Hospital

Abstract

Introduction: Patients with substance use disorders are at an increased risk of viral hepatitis and alcohol-related liver disease and, consequently, at higher risk of developing cholangiocarcinoma (CCA). Further, patients with substance abuse are often less compliant with healthcare screening strategies. We performed a retrospective study to evaluate the association of substance use disorders with CCA screening and outcomes. Methods: A manual chart review was performed for all patients diagnosed with CCA at a large urban safety-net hospital from 2010-2019. Patients were divided into two cohorts, CCA patients with and without a history of substance abuse. Patient characteristics, liver disease etiology, and radiologic screening intervals were recorded. CCA outcomes such as mortality rate, disease metastasis, and treatment decision at tumor board were noted. Statistical analyses were performed using Statistical Product and Service Solutions version 26.9 (SPSS, Inc., Chicago, Illinois). Qualitative and quantitative differences between groups were analyzed by Chi-squared or Fisher’s exact tests for categorical variables and t-test for continuous variables. Results: A total of 46 patients were identified with CCA. Among them, 11 patients (23.9%) had a history of substance abuse, while 35 patients (76.1%) did not have a history of substance abuse. CCA patients with a history of substance abuse were significantly younger (mean age 60 vs. 65) at diagnosis (Table). There were no significant differences in the adequacy of screening in CCA patients with or without a history of substance abuse. While not statistically significant, compared to those without substance abuse, patients with CCA and substance abuse trended toward a higher mortality rate (72.7% vs. 54.3%) and were more likely to be recommended a palliative approach at tumor board (72.7% vs. 57.1%) (Figure). Conclusion: Notably, those patients with substance abuse were diagnosed with CCA at a significantly younger age. Therefore, cirrhotic patients with substance abuse may benefit from earlier referral to specialist care with hopes of more adherence to screening exams. There is suggestion of worse outcomes in those with substance abuse, as they had higher deaths in follow up and higher likelihood of referral to palliative care upon diagnosis. Overall, this study emphasizes the need for more multidisciplinary linkage to care for this vulnerable patient population.Figure 1.: Screening adequacy and disease outcome in Cholangiocarcinoma patients with and without substance abuse. Legend: 1Therapeutic treatment options include resection, transplantation, ablation, or Transarterial chemoembolization. 2 Palliative treatment options include chemotherapy and hospice. Table 1. - Baseline characteristics of Cholangiocarcinoma patients with and without substance abuse CCA Total (n=46) Substance Abuse (n=11) No substance abuse (n=35) P-value Age (mean +/- sd) 64.4 +/- 11.1 60.9 +/- 5.4 65.5 +/- 12.2 0.0278 Gender Male 22 (47.8%) 8 (72.7%) 14 (40.0%) 0.0485 Female 24 (52.2%) 3 (27.7%) 21 (60.0%) Race African Americans 14 (30.4%) 2 (18.2%) 12 (34.3%) 0.2064 White 25 (54.3%) 7 (63.6%) 18 (51.4%) Asian 1 (2.2%) 0 (0%) 1 (2.9%) Ethnicity Hispanic 5 (10.9%) 2 (18.2%) 3 (8.6%) 0.2626 Non-Hispanic 41 (89.1%) 9 (81.8%) 32 (91.4%) Insurance Medicaid 14 (30.4%) 4 (36.4%) 10 (28.6%) 0.8376 Medicare 15 (32.6%) 4 (36.4%) 11 (31.4%) Financial Assistance 1 (2.2%) 0 (0%) 1 (2.9%) Private 9 (19.6%) 1 (9.1%) 8 (22.9%) No insurance 7 (15.2%) 2 (18.2%) 5 (14.3%) Liver disease HCV 11 (23.9%) 6 (54.5%) 5 (14.3%) 0.3049 Alcohol 7 (15.2%) 5 (45.5%) 2 (5.7%) NASH 3 (6.5%) 0 (0%) 3 (8.6%) HCV treatment HCV treated 1 (9.1%) 1 (16.7%) 0 (0%) 0.5455 HCV not treated 10 (90.9%) 5 (83.3%) 5 (100%) Abbreviations: HCV hepatitis C virus, NASH = Non-alcoholic steatohepatitis