Helmneh M. Sineshaw, M.D., M.P.H., from the American Cancer Society in Atlanta, and colleagues examined treatment patterns for patients newly diagnosed with metastatic lung, colorectal, breast, or pancreatic cancer who died within one month of diagnosis. A total of 100,848 patients who were diagnosed between 2004 and 2014 were identified.
The researchers observed substantial variation in treatment by cancer type, age, insurance, and facility type and over time. Surgery varied from 0.4 to 28.3 percent for patients with pancreatic and colorectal cancer (CRC), respectively; chemotherapy varied from 5.8 percent in patients with CRC to 11 percent in lung and breast cancer patients; and radiotherapy varied from 1.3 to 18.7 percent in pancreatic and lung cancer patients, respectively. Between 2004 and 2014, use of some treatments (for example, surgery for CRC and breast cancer) progressively decreased. The odds of radiation were 48 percent lower for patients treated at community cancer centers versus those treated at National Cancer Institute-designated cancer centers.
"More research is needed to specifically identify patients with imminently fatal metastatic cancer who will not benefit from attempted life-prolonging treatment, who should instead be referred for end-of-life care," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry; one author has a patent pending for a surgical specimen collection kit.
