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Treating patients with late-stage metastatic cancer ‘not a rare phenomenon’
Many patients with stage IV metastatic cancer who died within a month of diagnosis received cancer-related treatment, according to study in JNCI Cancer Spectrum.
The study found broad variations in treatment rates according to cancer type, treatment modality and the type of cancer center.
“Patients with newly diagnosed metastatic cancer are unique — especially those who die within a short time of diagnosis,” Helmneh M. Sineshaw, MD, MPH, a principal scientist in health services research at the American Cancer Society, told HemOnc Today. “The patterns of treatment in this group is something that is rarely examined, and we were highly interested to examine these patterns among this group of patients.”
Researchers used data from the National Cancer Database (NCDB) registry and examined trends in treatment (surgery, chemotherapy, radiotherapy or hormone-based therapy) among patients with newly diagnosed metastatic lung, colorectal, pancreatic or breast cancer who died within 1 month of diagnosis.
Researchers required that patients be treated at the reporting facility, have AJCC stage IV disease at diagnosis, and be aged 18 years or older.
Receipt of first-line therapy for newly diagnosed metastatic cancer within 1 month of diagnosis served as the study’s primary outcome.
The multivariate logistic regression analysis included 100,848 patients (44% aged 75 years or older; 77% non-Hispanic white). Most patients (60%) received treatment at centers that dealt with a high volume of newly diagnosed metastatic cancers.
Sixty-six percent of patients had lung cancer, 18% had pancreatic cancer, 12% had colorectal cancer and 3.6% had breast cancer.
Nearly three quarters (72.6%) of patients in the study did not receive any cancer-related therapy. However, results showed significant variation in treatment rates when broken down by cancer type, ranging from 12.5% of patients with pancreatic cancer who received at least one treatment modality to 37.2% of patients with colorectal cancer (lung cancer, 29%; breast cancer, 34.9%).
Treatment of these patients with a poor prognosis “was not a rare phenomenon,” and treatment rates were “higher than we expected,” Sineshaw told HemOnc Today.
Surgery of the primary tumor was the least common treatment modality among those with pancreatic cancer (0.4%) and most common among those with colorectal cancer (28.3%). Patients with lung cancer appeared most likely to receive radiotherapy (18.7%), whereas 11.3% of patients with lung or breast cancer received chemotherapy and 23.9% of those with hormone receptor-positive breast cancer received hormone-based therapy.
Sineshaw said these results are a clear indicator that oncologists recommend treatment more frequently for certain types of late-stage metastatic cancer.
“For example, for colorectal or breast cancer, they may be more optimistic in giving treatments the hope that those treatments will prolong their patient’s life. Whereas for a deadly cancer like pancreatic cancer, they know their ability to predict survival is clearer and that the patient will not live much longer,” he said.
Patients treated at community cancer centers had 40% lower odds of undergoing primary tumor surgery, and 48% lower odds of receiving radiotherapy for lung cancer then patients treated at NCI-designated cancer centers.
The investigators explained that the variations in care may be even greater among the U.S. population because they used NCDB registry data, which is taken from accredited institutions that typically provide a higher level of care than nonaccredited cancer treatment centers. In addition, the analysis included all causes of death within 1 month of diagnosis and did not differentiate between cancer-related and noncancer-related deaths.
“Our goal was to provide ‘real-world’ information on patterns of care in patients who quickly succumbed to their disease,” Sineshaw and colleagues wrote. “This information may be useful in identifying patients who may benefit from better integration of palliative care and may be good candidates for hospice care, which cannot always be initiated concurrently with active treatments.”
Sineshaw offered HemOnc Today additional takeaways from the study: “It can help physicians, oncologists and patients with their decision-making — whether to focus on quality of care vs. life-prolonging treatments. There should be a clear discussion with patients who have grim prognoses and short survival times. It can also help further research into identifying patient groups who would benefit from life-prolonging treatments and better prognostication of survival in these groups.” – by Drew Amorosi
For more information:
Helmneh M. Sineshaw, MD, MPH, can be reached at American Cancer Society, 250 Williams St. NW, Atlanta, GA 30303; email: helmneh.sineshaw@cancer.org.
Disclosures: Sineshaw is supported by grants from the American Cancer Society and NIH/NCI; he reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.