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Treatment of Patients With Imminently Fatal de Novo Metastatic Cancer

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Key Points

  • The research team found wide variations in treatment by cancer type, over time, age, insurance, and type of treatment facility.
  • The researchers concluded, “These variations warrant more research to better identify patients with imminently fatal de novo metastatic cancer who may not benefit from aggressive and expensive therapies.”

Some patients who died within 1 month of being newly diagnosed with metastatic cancer in the United States received ineffective surgery, chemotherapy, radiotherapy, and hormonal therapy, according to a new study published by Sineshaw et al in JNCI Cancer Spectrum. The study authors said the findings highlight the need to better identify patients with imminently fatal metastatic cancer who may not benefit from aggressive and expensive therapies.

Methods

Little is known about patterns of and factors associated with treatment of patients with de novo metastatic cancer who die soon after diagnosis. For the study, a team led by Helmneh Sineshaw, MD, MPH, and including researchers from the American Cancer Society, Dana-Farber Cancer Institute, Baptist Cancer Center, and Mayo Clinic College of Medicine examined treatment patterns for 100,848 adult patients in the National Cancer Data Base. All were newly diagnosed with metastatic lung, colorectal, breast, or pancreatic cancer and died within 1 month of diagnosis.

Findings

The research team found wide variations in treatment by cancer type, over time, age, insurance, and type of treatment facility. Surgery rates ranged from 0.4% of patients with pancreatic cancer to 28.3% of patients with colorectal cancer. Chemotherapy use ranged from 5.8% of patients with colorectal cancer to 11% of patients with lung and breast cancers. Radiotherapy rates ranged from 1.3% in patients with pancreatic cancer to 18.7% of patients with lung cancer.

Use of some treatment—for example, surgery for colorectal and breast cancers—declined over time. Patients with lung cancer treated at community cancer centers had 48% lower odds of radiation than those treated at National Cancer Institute–designated cancer centers.

The study authors concluded, “Treatment of patients diagnosed with imminently fatal de novo metastatic cancer varied markedly by cancer type and patient/facility characteristics. These variations warrant more research to better identify patients with imminently fatal de novo metastatic cancer who may not benefit from aggressive and expensive therapies.”

Disclosure: The study authors’ full disclosures can be found at academic.oup.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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