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

by U.S. Medicine

July 12, 2012

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)

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

Zoledronic Acid Therapy Improves Subgroup Breast Cancer Survival

Zoledronic acid (ZOL) therapy administered with chemotherapy appears to improve disease-free survival and overall survival in a subset of breast cancer patients with oestrogen receptor negative tumors, according to researchers from the John Cochran VAMC and the Washington University School of Medicine, both in St. Louis.

The study, published recently in the British Journal of Cancer, notes that women with resectable Stage II/III breast cancer have a high risk of recurrent disease, despite neoadjuvant/adjuvant chemotherapy. Recent data suggests that ZOL therapy concurrent with adjuvant treatments could improve cancer-related outcomes in those patients, the authors wrote. 1

Researchers evaluated disease-free survival and overall survival in 119 women with Stage II/III breast cancer divided into two groups. One received 4 mg of ZOL therapy every three weeks for a year, starting with the first chemotherapy cycle. The control group did not receive ZOL therapy.

No significant difference in recurrence or survival was noted between the study group and the control at 61.9 months median follow-up, but time until recurrence and death rates differed significantly between subgroups defined by oestrogen-receptor status.

Hazard ratios for disease recurrence and death were significantly less among patients with oestrogen receptor negative tumors who received ZOL therapy, as opposed to those who had not received the therapy (DFS: HR=0.361, 95% confidence interval (CI) 0.148, 0.880; OS: HR=0.375, 95% CI 0.143, 0.985)

The authors caution that, because of researcher limitations, the study should be considered as “hypothesis-generating” and not conclusive.

1: Aft RL, Naughton M, Trinkaus K, Weilbaecher K. Effect of (Neo)adjuvant
zoledronic acid on disease-free and overall survival in clinical stage II/III
breast cancer. Br J Cancer. 2012 May 22. doi: 10.1038/bjc.2012.210. [Epub ahead
of print] PubMed PMID: 22617128.

 

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

Demographic Factors Influence VA Use by Terminally Ill Patients

Race and marital status can influence how often terminally ill cancer patients use VA health system services, according to a study presented recently at the American Society for clinical oncology. 1

The “findings have implications for cost of care and should be confirmed in larger studies in our veterans, including caregivers,” the authors said in the abstract of the study.

The study, which was partly funded by Project Death in America, noted that little information exists about how socio-demographic factors influence health services utilization for terminal cancer patients receiving palliative care.

For the 2002-2004 study, researchers followed 103 advanced cancer patients receiving palliative care in the Section of Hematology Oncology at a VA Medical Center, but not hospice, every four to six weeks from the start of palliative care until death. The study sample included a subset of 39 patients who received palliative care for at least 24 weeks.

In the subset were 17 Caucasians, 21 African-Americans and one of “other” race. Of those, 21 were married, seven were divorced, six were widowed, four never married and one had unknown marital status. The majority of patients had either prostate cancer (39.47%) or lung cancer (28.95%).

Charts were reviewed retrospectively for measures of health system utilization, including total length of hospital days, number of admissions, number of clinic visits and emergency department visits.

For the group, the mean total number of inpatient days was 23.6, mean number of admissions was 2.9, mean number of clinic visits was 27 and ED visits was 1.3 per patient. How often those services were used varied by socio-demographic factors, however.

Mean total hospital days were longer for African-Americans (25) than Caucasians (17.7); the patient of “other” race had a total of 94 hospital days. The average number of ED visits was 0.48 for Caucasians, 2.0 for African-Americans and 0 for other.

Total number of inpatient days was longest for those who were never married (33.8 days) and less for those who were married (26.0), divorced (12.7) or widowed (9.3). A similar trend was found for clinic visits.
1. J Clin Oncol 30, 2012 (suppl; abstr e19639)

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