Stage IV cancer often not treated

One patient in five who presents with a stage IV solid-tumor cancer does not receive treatment directed at the cancer, researchers found. Anti-cancer treatment for newly diagnosed metastatic disease varied significantly according to factors that may not be related to informed preferences for treatment, according to Matthew Galsky, MD, of Mount Sinai School of Medicine in New York City, and colleagues. Those factors associated with lack of anti-cancer therapy included age, race, insurance status, and income -- in directions suggesting that socioeconomic deprivation predicts less aggressive treatment, the analysis of a large U.S. database showed. In the study abstract, published prior to presentation here at the American Society of Clinical Oncology's annual meeting, Galsky and colleagues noted that clinicians have long been aware that some patients whose cancers are first diagnosed at the metastatic stage never receive specific cancer-directed therapy. Often this is for valid reasons, such as patient preference and/or overall illness burden that may make them poor candidates for the rigors of aggressive anti-cancer treatment. But the frequency with which late-stage cancers go untreated and the characteristics of such patients have not been studied before, the researchers indicated. Galsky and colleagues went to the National Cancer Database and pulled records for some 773,000 patients with nine types of stage IV disease from 2000 to 2008. The nine types were cancers of the breast, cervix, colon, rectum, prostate, uterus, and kidney, plus small cell and non-small cell lung cancer. About three-quarters of these cases involved the two types of lung cancer and colon cancer. Overall, the records indicated that about 159,000 patients (20.6%) received neither radiation nor systemic drug therapy, the data indicated. Galsky and colleagues found the following prevalence ratios (PR) for lack of anti-cancer therapy related to specific patient characteristics: Older age: PR 1.37 to 1.49 across the nine cancer types, all P