Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy

Alexander C. Small, Che Kai Tsao, Erin L. Moshier, Benjamin A. Gartrell, Juan P. Wisnivesky, James H. Godbold, Cardinale B. Smith, Guru Sonpavde, William K. Oh, Matthew D. Galsky

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND: A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS: The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS: Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%-20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37-1.49; all P <.001), black race (PR range, 1.05-1.32; all P <.001), lack of medical insurance (PR range, 1.47-2.46; all P <.001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P <.001]) were associated with a lack of treatment. CONCLUSIONS: Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care.

Original languageEnglish (US)
Pages (from-to)5947-5954
Number of pages8
JournalCancer
Volume118
Issue number23
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Neoplasms
Therapeutics
Non-Small Cell Lung Carcinoma
Uterine Neoplasms
Health Services Accessibility
Patient Preference
Kidney Neoplasms
Population Characteristics
Health Policy
Insurance
Rectum
Cervix Uteri
Uterus
Comorbidity
Prostate
Lung Neoplasms
Prostatic Neoplasms
Colon
Breast
Radiotherapy

Keywords

  • health care disparities
  • metastatic cancer
  • National Cancer Data Base
  • no treatment
  • untreated

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Small, A. C., Tsao, C. K., Moshier, E. L., Gartrell, B. A., Wisnivesky, J. P., Godbold, J. H., ... Galsky, M. D. (2012). Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy. Cancer, 118(23), 5947-5954. https://doi.org/10.1002/cncr.27658

Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy. / Small, Alexander C.; Tsao, Che Kai; Moshier, Erin L.; Gartrell, Benjamin A.; Wisnivesky, Juan P.; Godbold, James H.; Smith, Cardinale B.; Sonpavde, Guru; Oh, William K.; Galsky, Matthew D.

In: Cancer, Vol. 118, No. 23, 01.12.2012, p. 5947-5954.

Research output: Contribution to journalArticle

Small, AC, Tsao, CK, Moshier, EL, Gartrell, BA, Wisnivesky, JP, Godbold, JH, Smith, CB, Sonpavde, G, Oh, WK & Galsky, MD 2012, 'Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy', Cancer, vol. 118, no. 23, pp. 5947-5954. https://doi.org/10.1002/cncr.27658
Small, Alexander C. ; Tsao, Che Kai ; Moshier, Erin L. ; Gartrell, Benjamin A. ; Wisnivesky, Juan P. ; Godbold, James H. ; Smith, Cardinale B. ; Sonpavde, Guru ; Oh, William K. ; Galsky, Matthew D. / Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy. In: Cancer. 2012 ; Vol. 118, No. 23. pp. 5947-5954.
@article{f1d5014e50354a4ab2c0695e671947f4,
title = "Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy",
abstract = "BACKGROUND: A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS: The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS: Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6{\%}; 95{\%} confidence interval, 20.5{\%}-20.7{\%}) received no anticancer therapy. Patients with NSCLC accounted for 55{\%} of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5{\%} and 24.0{\%}, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1{\%}. Across all cancer types, older age (PR range, 1.37-1.49; all P <.001), black race (PR range, 1.05-1.32; all P <.001), lack of medical insurance (PR range, 1.47-2.46; all P <.001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P <.001]) were associated with a lack of treatment. CONCLUSIONS: Approximately 20{\%} of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care.",
keywords = "health care disparities, metastatic cancer, National Cancer Data Base, no treatment, untreated",
author = "Small, {Alexander C.} and Tsao, {Che Kai} and Moshier, {Erin L.} and Gartrell, {Benjamin A.} and Wisnivesky, {Juan P.} and Godbold, {James H.} and Smith, {Cardinale B.} and Guru Sonpavde and Oh, {William K.} and Galsky, {Matthew D.}",
year = "2012",
month = "12",
day = "1",
doi = "10.1002/cncr.27658",
language = "English (US)",
volume = "118",
pages = "5947--5954",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "23",

}

TY - JOUR

T1 - Prevalence and characteristics of patients with metastatic cancer who receive no anticancer therapy

AU - Small, Alexander C.

AU - Tsao, Che Kai

AU - Moshier, Erin L.

AU - Gartrell, Benjamin A.

AU - Wisnivesky, Juan P.

AU - Godbold, James H.

AU - Smith, Cardinale B.

AU - Sonpavde, Guru

AU - Oh, William K.

AU - Galsky, Matthew D.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - BACKGROUND: A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS: The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS: Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%-20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37-1.49; all P <.001), black race (PR range, 1.05-1.32; all P <.001), lack of medical insurance (PR range, 1.47-2.46; all P <.001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P <.001]) were associated with a lack of treatment. CONCLUSIONS: Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care.

AB - BACKGROUND: A subset of patients who present with metastatic solid tumors never receive anticancer therapy. Reasons may include poor functional status, comorbidities, and patient preference. To the authors' knowledge, the prevalence and characteristics of this population have not previously been described. METHODS: The National Cancer Data Base was queried for patients diagnosed with metastatic (stage IV according to the American Joint Committee on Cancer) solid tumors (including those of the breast, cervix, colon, and kidney; small cell and nonsmall cell lung cancer [NSCLC]; and tumors of the prostate, rectum, and uterus) who received neither radiotherapy nor systemic therapy. Log-binomial regression analysis was used to estimate prevalence ratios (PRs) for the percentage of untreated to treated patients with stage IV cancer. RESULTS: Between 2000 and 2008, 773,233 patients with stage IV cancer were identified, 159,284 of whom (20.6%; 95% confidence interval, 20.5%-20.7%) received no anticancer therapy. Patients with NSCLC accounted for 55% of the untreated population. Patients with cancers of the kidney and lung had the highest rates of no treatment at 25.5% and 24.0%, respectively, whereas patients with prostate cancer had the lowest rate of no treatment at 11.1%. Across all cancer types, older age (PR range, 1.37-1.49; all P <.001), black race (PR range, 1.05-1.32; all P <.001), lack of medical insurance (PR range, 1.47-2.46; all P <.001), and lower income (except for cancer of the uterus; PR range, 0.91-0.98 for every $10,000-increase in income [all P <.001]) were associated with a lack of treatment. CONCLUSIONS: Approximately 20% of patients who present with stage IV solid tumors do not receive anticancer therapy. Although there are likely multiple reasons for this lack of treatment, including appropriate indications, these findings have potential implications with regard to health care policy and access to care.

KW - health care disparities

KW - metastatic cancer

KW - National Cancer Data Base

KW - no treatment

KW - untreated

UR - http://www.scopus.com/inward/record.url?scp=84869508454&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869508454&partnerID=8YFLogxK

U2 - 10.1002/cncr.27658

DO - 10.1002/cncr.27658

M3 - Article

VL - 118

SP - 5947

EP - 5954

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 23

ER -