Care delivery among patients with early-onset versus average-onset cholangiocarcinoma: a nationwide retrospective analysis

Background Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with increasing incidence and poor prognosis. Although traditionally considered a disease of older adults, early-onset CCA (EOCCA; age <50 years) may represent a clinically distinct subgroup. Data evaluating diagnostic and treatment trajectories in EOCCA remain limited. Patients and methods Using the Komodo Healthcare Map claims database (2017-2024), patients with CCA were identified using International Classification of Diseases, 10th Revision, codes and categorized as having EOCCA or average-onset CCA. Outcomes included time from first diagnosed symptom to CCA diagnosis, diagnostic delay (≥30 days), time to first intervention, and type of first intervention. Multivariable logistic, log-gamma, and competing-risk regression models evaluated associations between demographic and insurance factors and care delivery outcomes. Results Among 116 106 patients with CCA, 5146 (4.4%) had EOCCA. Of 43 137 patients with symptoms documented in their claims data, EOCCA was independently associated with longer time to diagnosis [expβ 1.13, 95% confidence interval (CI) 1.07-1.20, P < 0.001] and higher odds of diagnostic delay of ≥30 days [odds ratio (OR) 1.24, 95% CI 1.12-1.36, P < 0.001]. Overall time to first intervention did not differ significantly between cohorts; however, patients with EOCCA were more likely to receive cancer-directed therapy (OR 1.12, 95% CI 1.01-1.25). Within the EOCCA cohort, longer diagnostic intervals reduced the likelihood of intervention, and disparities in treatment receipt were observed among racial minorities and publicly insured patients. Conclusions The EOCCA cohort represents a clinically vulnerable population characterized by significant diagnostic delays and sociodemographic disparities in care delivery. Earlier recognition and system-level interventions to improve access and streamline diagnostic pathways are needed to optimize outcomes in younger patients with CCA.