No Treatment for 20% of Patients with Late-Stage Cancer Tumors

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About 20% of patients presenting with Stage IV solid tumors never receive anticancer therapy, including more than 12% of those with breast cancer, according to a new study presented at the recent meeting of the American Society for Clinical Oncology. 1

“These findings have potential implications with regard to healthcare policy and access to care,” according to the authors from Michael E. DeBakey VAMC and Baylor College of Medicine, both in Houston, and Mount Sinai School of Medicine in New York.

According the study background, “Clinicians caring for patients with cancer are well aware that a subset of patients who present with metastatic solid tumors never receive anticancer therapy for reasons including poor functional status, comorbidities and patient preference.”

Authors noted that the prevalence and characteristics of this population previously have not been described and sought to do so.

They queried the National Cancer Database for patients diagnosed with metastatic (Stage IV) solid tumors including breast, cervix, colon, kidney, small-cell and non-small cell lung, prostate, rectum and uterus, identifying patients who received neither radiation therapy nor systemic therapy.

Age, race, income, insurance status and diagnosis year also were examined and used to estimate prevalence ratios (PR) for the proportion of untreated Stage IV to treated Stage IV cancer cases.

The study found that, from 2000-2008, 773,233 patients with Stage IV cancer were identified, and 159,284 (21%) received no anticancer therapy.

Prevalence of patients with metastatic cancer who receive no anticancer therapy (2000-2008).

Cancer Type

Untreated
Stage IV

Total
Stage IV

% untreated

Cancer-specific
% of total
untreated cases

Kidney

12,079

47,417

25.5%

7.6%

NSCLC

87,400

353,748

24.7%

54.9%

Uterus

297

1,217

24.4%

0.2%

SCLC

21,085

99,206

21.3%

13.2%

Rectum

4,305

26,140

16.5%

2.7%

Colon

18,816

119,748

15.7%

11.8%

Cervix

1,407

9,535

14.8%

0.9%

Breast

7,313

57,148

12.8%

4.6%

Prostate

6,582

59,074

11.1%

4.1%

Total

159,284

773,233

20.6%

100.0%

More than half of the untreated patients, 55%, had non-small cell lung cancer.

Other factors related to increased prevalence of receiving no treatment included older age (PR range 1.37-1.49, all p<0.001), black race (PR range 1.05-1.32, all p<0.001), lack of medical insurance (PR range 1.47-2.46, all p<0.001) and lower income (except uterine  cancer) (PR range 0.91-0.98 for every $10,000 income, all p<0.001).

1. J Clin Oncol 30, 2012 (suppl; abstr 6065)

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