Perspectives and preferences on palliative chemotherapy-immunotherapy in gallbladder cancer patients.

Abstract

Background: Patients' perspective and preferences about the chemotherapy are not known. This study investigates the perspectives and treatment preferences of Indian gallbladder (GBC) patients.

Methods: A prospective 18-month study at a tertiary cancer center in Mumbai enrolled patients with histologically confirmed GBC receiving palliative chemotherapy, who were counselled in a structured format regarding disease, treatment options, outcomes and drug costs. Data were collected through structured interviews using quality-of-life and decision-making questionnaires. Descriptive statistics were used to analyse patient responses. A pilot sample of 30 patients was used to assess whether ≥90% prioritise survival as the primary expectation from chemo-immunotherapy. Using an exact one-sided binomial design, ≤23 responses favouring survival would indicate the proportion is <90% and warrant further study. We also evaluated the psychological distress among these patients.

Results: Among 30 participants (56.67% female), 83.33% were of advanced stage. Baseline demographics is depicted. Treatment priorities varied: 40% preferred life prolongation, 23.33% favoured symptom relief and 36.67% valued both equally. Financial burden strongly influenced decisions about immunotherapy, only 6.67% were willing to pay ₹35 lakhs out-of-pocket for a 1.5-month gain, while 100% would take treatment if it were government-funded. Emotional distress was significant, with a mean NCCN score of 6.21 ± 1.80. Major concerns included financial strain (42%), fear (45%) and depression (33%).

Conclusion: Twenty-three percent of patients favoured only symptom relief as a treatment when they were educated about the outcomes. A larger study is warranted to further consolidate our findings.