Patients With Advanced Cancer Often Choose Aggressive Treatments, Despite Questionable Benefits

Even with terminal diagnoses, up to 25 percent of patients with advanced cancer who are given less than one month to live resort to aggressive, expensive – and often unproven – interventions, according to a study in JNCI Cancer Spectrum.

Using data from the National Cancer Database, researchers studied more than 100,000 adult patients newly diagnosed with advanced lung, breast, pancreatic, or colon cancer in the U.S. between 2004 and 2014, who died within one month of diagnosis.

Of these patients, nearly 73 percent did not receive any type of cancer-directed treatment, but the remainder underwent surgery, chemotherapy, or other active treatment during their final weeks of life.

The type of cancer plays a substantial role in a patient’s decision to seek treatment: More than 28 percent of patients with colon cancer underwent surgery in their final weeks, while less than 1 percent of those with advanced pancreatic cancer did so. Nineteen percent of patients with lung cancer tried radiation therapy, but only 1 percent of those with pancreatic cancer did the same.

Younger patients without other chronic illnesses were more likely to choose aggressive treatment, as were those with private health insurance and those being treated at National Cancer Institute–designated centers (as opposed to community cancer centers).

According to lead study author Helmneh M. Sineshaw, MD, MPH, from the American Cancer Society, “Patients newly diagnosed with metastatic cancer who die soon after diagnosis are a unique population.” The findings, he noted, suggest a need to identify people who would benefit from palliative care for symptom and stress relief, instead of costly, aggressive treatments.

Sources: HealthDay, April 16, 2019; Sineshaw HM, Jemal A, Ng K, et al. Treatment patterns among de-novo metastatic cancer patients who died within one month of diagnosis. JNCI Cancer Spectrum. 2019 April 15.