Aggressive cancer treatment that likely provides no life-extending benefit is common shortly before the death of people with various metastatic malignancies, MedPage Today reports.
Publishing their findings in JNCI Cancer Spectrum, researchers analyzed data from the National Cancer Database covering 2004 to 2014. They specifically looked at those who died within one month of receiving a de novo diagnosis of one of four types of metastatic cancer, including pancreatic, colorectal, lung and breast cancer. (De novo means that these cancers were not diagnosed prior to metastasizing, or spreading from their original source.) The treatment types included in the analysis included chemotherapy, hormonal therapy, radiation therapy and surgery.
A total of 100,848 people were included in the analysis, including 66.5% with lung cancer, 18% with pancreatic cancer, 12% with colorectal cancer and 3.6% with female breast cancer. Seventy-seven percent of the cohort members were white, and 44% were 75 years old or older. Sixty percent were treated at health care facilities that treat de novo metastatic cancer care among a large number of patients.
A total of 27.4% of the cohort received one of the four forms of aggressive cancer treatment within one month of dying, including 37.2% of those with colorectal cancer, 34.9% of the women with breast cancer, 29% of those with lung cancer and 12.5% of those with pancreatic cancer.
The cancer types with the respective highest and lowest proportion receiving each type of aggressive treatment were as follows: 28.3% of those with colorectal cancer and 0.4% of those with pancreatic cancer received surgery to the primary tumor (the source of the metastatic cancer); 11.3% of those with lung and breast cancer and 5.8% of those with colorectal cancer received chemotherapy; 18.7% of those with lung cancer and 1.3% of those with pancreatic cancer received radiotherapy; and 23.9% of those with hormone-receptor-positive breast cancer (breast cancer that has receptors for estrogen or progesterone) received hormonal therapy.
The rates of aggressive treatment declined during the study period when it came to primary surgery for colorectal and breast cancer, chemotherapy for lung, breast and pancreatic cancer and radiation therapy for lung and breast cancer.
Being 75 years old or older, compared with being 18 to 39 years old, was associated with a lower rate of radiotherapy and chemotherapy for lung cancer and also chemotherapy for breast cancer. Having a higher comorbidity score (meaning having a higher burden of other illnesses) was tied to a lower rate of chemotherapy among those with pancreatic cancer and radiotherapy among those with lung cancer. Not having insurance was associated with a lower rate of primary surgery for colorectal cancer, radiotherapy for lung cancer and chemotherapy for all the cancers included in the analysis.
“Treatment of patients diagnosed with imminently fatal de novo metastatic cancer varied markedly by cancer type and patient/facility characteristics,” the study authors 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.”
To read the MedPage Today article, click here.
To read the study, click here.