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According to new findings, some patients recently diagnosed with metastatic cancer and who died within one month of their diagnosis received aggressive but ineffective treatment.
However, there were marked variations in treatment depending on the type of cancer, the age of the patient, the insurance coverage and the type of treatment facility.
For example, the investigators found that among more than 100,000 patients, 12.5% of people with pancreatic cancer, 29% of those with lung cancer, 34.9% of those with those with bad cancer and 37.2% of those with colorectal cancer had received at least one type of cancer. despite their diagnosis of metastatic cancer de novo.
The authors found that the odds of receiving chemotherapy were lower in older patients, regardless of the type of cancer. Older patients with lung cancer were less likely to receive radiation therapy.
The odds of receiving chemotherapy and radiation were also lower in patients with lung and pancreatic cancer who had higher comorbidity scores. Among uninsured patients, the odds of receiving chemotherapy were lower for those with lung cancer or bad cancer. The type of treatment offered varied considerably by type of institution.
The data being extracted from a database, the authors were not able to determine why some patients were treated and others not.
"Determining the appropriateness of care for these patients is very difficult because they form a unique population that dies shortly after a diagnosis of metastatic cancer," said lead author, Helmneh Sineshaw, MD, scientist, Health Services Research, American Cancer Society. .
"The decision to administer aggressive treatment requires a better prognosis to guide care decisions and should involve doctors, patients and their families," he said. Medscape Medical News. "We need a better prognosis for patients with de novo metastatic cancer occurring in an imminent state of mortality in order to guide care decisions and avoid unnecessary treatments, aggressive and expensive. "
The study was published online on April 15 in JNCI cancer spectrum.
De novo metastatic diseases account for a significant proportion of mortality from lung cancer, colorectal cancer, bad and pancreas. In the United States, these four cancers are among the leading causes of cancer deaths. Even with therapeutic advances, many patients die soon after being diagnosed.
However, the authors note, the relevance and quality of care is difficult to determine in this patient population and the treatment regimens are not well characterized.
Variations across types of cancer
For their study, Sineshaw and colleagues identified 100,848 adult patients in the national cancer database with lung cancer, colorectal cancer, bad cancer or de novo metastatic pancreas diagnosed between 2004 and 2014 and died within 1 month of diagnosis. They evaluated the use of surgery, chemotherapy, radiotherapy and hormone therapy in this population in order to provide "real" information on the trends in care in the deceased few patients. time after receiving their diagnosis.
In the cohort, 66.5% of the patients had lung cancer, 18% a pancreatic cancer, 12% a colorectal cancer and 3.6% were women with bad cancer. More than three-quarters of patients (77%) were Caucasian, 44% were 75 years of age or older, and 60% had been treated in facilities where the number of cases of de novo metastatic cancer was high. Among patients with a comorbidity score ≥2, lung cancer accounted for the highest percentage (21%).
The reception of the treatment varied according to the type of cancer. Of the patients who received at least one type of treatment, 12.5% had pancreatic cancer, 29% had lung cancer, 34.9% had bad cancer and 37.2% had colorectal cancer; 72.6% received no type of treatment directed against cancer.
The use of different types of treatment directed against cancer varied considerably depending on the type of cancer. For example, surgery was most commonly used in patients with colorectal cancer (28.3%); it was less used in patients with pancreatic cancer (0.4%). The use of chemotherapy ranged from 5.8% in patients with colorectal cancer to 11.3% in patients with lung or bad cancer; 18.7% of patients with lung cancer received radiation therapy, compared with 1.3% of those with pancreatic cancer.
In further badysis, the authors found that chemotherapy was relatively used in patients diagnosed with small cell lung cancer (27%); 23.9% of women with hormone receptor-positive bad cancer received hormone therapy.
Patient factors play a role
Sineshaw and colleagues also evaluated other factors that may affect the likelihood of receiving aggressive treatment. This treatment also varied according to the type of treatment and the type of cancer. Older lung cancer patients (aged 75 years or older) had a 46% to 70% probability of radiotherapy and a 77% to 92% lower probability of chemotherapy than younger patients (18 to 39%). years). Among patients with bad cancer, the odds of receiving chemotherapy were 65% to 99% lower than those of younger patients.
In patients with a high comorbidity score (2+), those with pancreatic cancer were 25% less likely to receive chemotherapy compared to those with no comorbid disease; Lung cancer patients who had a high comorbid score were 33% less likely to receive radiation therapy.
Insurance has also played a role. The odds of undergoing surgery for a primary tumor of colorectal cancer were 47% lower in uninsured patients and 14% less likely to benefit from radiotherapy for lung cancer. For each type of cancer, the odds of receiving chemotherapy were 35% to 56% lower.
During the study period, in patients with colorectal cancer or bad cancer, the use of primary tumor surgery has been steadily decreasing. In patients with lung or bad cancer, the use of chemotherapy and radiation therapy has also steadily decreased, as has the use of chemotherapy in patients with lung cancer. 39, pancreatic cancer (for all, P trend <0.01).
In addition, the authors found that treatment modalities varied according to the type of facility in which care was provided.
"There are a number of factors that could influence whether or not to treat these patients for the purpose of prolonging life," Sineshaw said. "Our findings underscore the need for further research to specifically identify patients with metastatic cancer on the verge of death, who will not benefit from any life-prolonging treatment attempts because those who have received a treatment died shortly after diagnosis. "
The study was funded by the American Society of Cancer Intramural Research and the National Institutes of Health / National Cancer Institute. Sineshaw has not disclosed any relevant financial relationship.
JNCI Cancer Spectr. Posted online 15 April 2019. Summary
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