56Global Patient Interviews Exploring the Journey from Symptoms to Diagnosis and Treatment Initiation in Biliary Tract Cancer

Background and Objectives

The objective of this study was to describe the journey from initial symptom presentation to diagnosis and initiation of treatment for biliary tract cancer (BTC) from the patients’ perspective, focusing on barriers and challenges across the US, Canada, UK, Germany, and Japan.

Methods

Qualitative semi-structured interviews were conducted with adults diagnosed with early- and late-stage BTC. Interviews explored different domains of the diagnostic journey, from initial presentation and seeking care to diagnosis and treatment. Inductive and deductive coding was applied to identify overarching themes. Interim results from 30 interviews are presented herein.

Results

In this interim analysis, 30 patients with BTC were interviewed: US (N = 11), Canada (N = 10), UK (N = 3), and Germany (N = 6). Table 1 summarizes findings on barriers to diagnosis and treatment initiation. Over half of patients were diagnosed at late stage. Many initially reported no or non-BTC-specific symptoms, contributing to delays in diagnostic work-up or misdiagnosis.

Patients delayed seeking care as they perceived symptoms as less serious, self-limiting, or were asymptomatic. Attitudinal and informational barriers were the primary drivers of delays in seeking care, whereas structural and logistical barriers were commonly cited as reasons for delays in receiving care (see Table 1). Barriers to diagnostic testing were similarly described as logistical in nature. Patients had multiple provider visits prior to diagnosis, with two-thirds reporting ≥3 visits.

Conclusion

Interim results identify several barriers and challenges to diagnosis experienced by patients with BTC, highlighting the need for greater awareness to improve early detection. Although sample sizes are small, consistent trends emerge across countries. Increasing awareness of BTC among the public and physicians, early workup of symptoms, and alleviating barriers such as long wait times and referrals prior to diagnosis to improve access may help increase timely BTC diagnosis thereby enabling timely treatment. The complete dataset may further inform improvements in diagnostic pathways.