Number of cancer survivors in U.S. rises to 18 million, disparities in care remain
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As the number of cancer survivors in the U.S. tops 18 million, ensuring quality care for this aging population remains a challenge, according to a study published in CA: A Cancer Journal for Clinicians.
The report from American Cancer Society, in collaboration with NCI, cited ongoing issues such as poor survivorship care integration between oncology and primary care, shortages in the clinician workforce and a lack of strong guidelines for posttreatment care, as well as racial disparities in treatment and survival for many common cancer types.
Rationale and methods
“We conduct this research every 3 years to update estimates of the number of cancer survivors living in the U.S. and provide a high-level summary of contemporary treatment patterns,” Kimberly D. Miller, MPH, researcher in surveillance and health equity science at American Cancer Society, told Healio. “However, this is the first time we have shown treatment data by race/ethnicity to highlight disparities in receipt of surgical and systemic therapies for some of the major cancer sites.”
Miller and colleagues used survival data from SEER cancer registries, vital statistics from the CDC and population projections from the U.S. Census Bureau to identify current treatment patterns for the most common cancer types according to race.
Key findings
The most common cancers among women included breast (n = 4,055,770), uterine corpus (n = 891,560) and thyroid (n = 823,800). Among men, the most common cancer types included prostate cancer (n = 3,523,230), cutaneous melanoma (n = 760,640) and colorectal cancer (n = 726,450).
Researchers found 53% of survivors had been diagnosed within the previous decade, and 67% were aged 65 years or older.
Although data from the National Cancer Database showed increased uptake of treatment advances, such as immunotherapy for stage IV non-small cell lung cancer — from 12% in 2016 to 33% in 2018 — they also revealed racial disparities in treatment.
Specifically, Black patients less commonly received surgery for NSCLC compared with white patients for stage I to stage II disease (49% vs. 55%) and for stage III disease (16% vs. 22%). Moreover, only 41% of Black patients with stage I rectal cancer received proctectomy or proctocolectomy vs. 66% of white patients, and Black women were less likely to be diagnosed with stage I uterine corpus cancer than white women (59% vs. 73%).
“I’m perhaps not surprised by these findings but am definitely reassured by the rapid uptake in immunotherapy for advanced NSCLC,” Miller said. “Lung cancer is the leading cause of cancer death in the U.S. and is often diagnosed late because it does not cause symptoms until the disease has advanced, so it is great to see progress in this area. However, we need to be vigilant in monitoring disparities in uptake and receipt, especially as NSCLC is one of the cancers for which we already note large existing treatment disparities.”
Study limitations included the fact that estimates cannot be compared with those previously published because they are model-based projections based on currently available population-based incidence, mortality and survival data through 2018, according to the researchers.
Looking ahead
The growing number of cancer survivors in the U.S. increases the burden on the public health community to provide services and recommendations not only to survivors, but also their care teams, Miller said.
“This study is one of many ongoing calls for increased guidance for care teams who are treating patients or helping them transition to another phase of cancer survivorship, especially during the COVID-19 pandemic era,” Miller said. “While we have seen progress in the number of tools available, I hope we can continue to see further advances in making sure these resources are equitably available to all communities. Our team is very interested in following the impact of the COVID-19 pandemic on cancer occurrence and on survivors themselves. We have several concerns that diagnosis and treatment delays may exacerbate many of the disparities we noted in our study and disproportionately burden communities of color, so will be watching this very closely.”
For more information:
Kimberly D. Miller, MPH, can be reached at American Cancer Society, 3380 Chastain Meadows Parkway NW, Suite 200, Kennesaw, GA 30144-0101; email: kimberly.miller@cancer.org.
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