Number of cancer survivors diagnosed with new malignancies increases 15%
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Key takeaways:
- The number of cancer survivors diagnosed with a new malignancy increased 15% from 2013 to 2019.
- The finding underscores the need to evaluate exclusion criteria of cancer clinical trials, researchers concluded.
The number of cancer survivors diagnosed with a new malignancy increased by 15% from 2013 to 2019, according to data published in JAMA Oncology.
“Our findings point to unique needs of cancer survivors,” researcher Caitlin C. Murphy, PhD, MPH, associate professor in the department of health promotion and behavioral sciences at UTHealth Houston School of Public Health, and colleagues wrote.
“The American Cancer Society, [ASCO] and National Comprehensive Cancer Network provide care guidelines for survivors, but only for a few specific cancers,” they added. “Developing evidence-based guidelines for long-term care of this population is critical to improving outcomes and mitigating risk [for] multiple cancers.”
Background and methods
The number of cancer survivors in the United States is expected to exceed 22 million by 2030, according to American Cancer Society.
A prior study showed 18.4% of adults diagnosed with an incident cancer between 2009 and 2013 had survived a prior malignancy. These individuals may have been excluded from clinical trials due to their prior cancer.
Murphy and colleagues sought to provide an update on this trend.
They used population-based data from NCI’s SEER database to estimate the prevalence of prior malignancy among U.S. adults diagnosed with an incident cancer in 2019. They also examined differences by age, sex, race and ethnicity.
Results
Researchers determined 1.73 million people in the United States had been diagnosed with a new cancer in 2019.
Results showed 19.4% of them had survived a prior cancer. These included 1.9% who survived a prior cancer of the same type, 8.6% who had survived a different form of cancer, and 8.9% who had survived an unknown type of prior cancer.
A diagnosis of a new incident cancer different from the prior malignancy appeared more common among older adults (14.1% for those aged 65 years or older vs. 1.6% for those aged 18 to 49 years). This also appeared more common among men than women (10.3% vs. 8.9%), and among non-Hispanic white individuals than non-Hispanic Black individuals (11% vs. 5.7%). Researchers also reported differences in prevalence by cancer type.
Implications
Approximately two-thirds of NCI-supported trials from 2018 to 2020 excluded patients with prior or concurrent cancers, the researchers reported.
“Recommendations against excluding patients from clinical trials solely on the basis of prior cancer are supported by growing evidence that persons newly diagnosed with cancer who have survived a prior cancer of a different type have equivalent survival compared with those without prior cancer,” Murphy and colleagues wrote. “Yet, implementation of these recommendations has been slow.”
Beyond evaluation of clinical trial exclusion criteria, the findings support the importance of improving equity in cancer care and addressing the unique needs of the growing number of cancer survivors, researchers concluded.
Perspective
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Dale R. Shepard, MD, PhD
The study by Murphy and colleagues shows a 15% increase in the number of cancer survivors with a new malignancy between 2013 and 2019. This has significant implications for survivorship plans and for clinical trials.From a survivorship perspective, nearly 20% of patients diagnosed with a cancer had a prior malignancy. Those who have been successfully treated for cancer — and their health care team — need to remain cognizant of the risks for a second tumor. Having one type of cancer isn’t protective to getting a different one. This study showed primarily the development of new cancers, not recurrence of a previous one.
My greatest concern from this study is the potential impact on access to clinical trials for those who develop a second cancer. We can only make progress toward better cancer therapies through clinical trials. Clinical trials are the best treatment option for many patients, particularly for those enrolling in early-phase studies.
Unfortunately, the number of patients enrolling in clinical trials remains very low, often cited as 5% to 10% of those being treated. There are many reasons, including geographic access and limited trials for those with some common types of cancer, such as advanced prostate, colon or pancreas cancers. It is incumbent on us to not place unnecessary barriers to trial enrollment. Inclusion criteria for clinical trials often are too restrictive for age or may place limits on hematologic parameters, or liver or kidney function for drugs not likely to affect these parameters.
Murphy and colleagues have pointed to the magnitude of another potential barrier to trial enrollment. Although some studies have parameters, too many trials don't allow patients with a prior malignancy to participate. Without thoughtful consideration for enrolling these patients, we could potentially limit enrollment of up to one in five patients. This is a population of individuals who survived one cancer and are now trying to get effective therapy for a second. They deserve access to any available therapies, including clinical trials.
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