The treatment that patients received for imminently fatal de novo metastatic cancer varied greatly by cancer type and patient or facility characteristics, according to a study examining treatment trends from 2004 to 2014.1

“Despite advances in cancer care, many patients diagnosed with de novo metastatic cancers die soon after diagnosis, with racial minorities, the uninsured, socioeconomically disadvantaged, and older patients disproportionately represented in this group,” study researchers wrote in JNCI Cancer Spectrum.

To find out more about contemporary patterns of care, researchers identified 100,848 adults from the National Cancer Data Base diagnosed with de novo metastatic lung (66.5%), colorectal (11.9%), breast (3.6%), and pancreatic cancer (18%) who died within 1 month of diagnosis. The majority of participants included patients were described by authors as non-Hispanic white.

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About three-quarters (72.6%) of patients did not receive any cancer-directed treatment. At least 1 treatment was given in 12.5% of patients with pancreatic, 29% of lung, 34.9% of breast, and 37.2% of patients with colorectal cancers.

Surgery of the primary tumor was employed the least amount in pancreatic cancer (0.4%) and the most in colorectal cancer (28.3%); however, the researchers noted that use of surgery in colorectal cancer decreased from 2004 to 2014.

Use of chemotherapy ranged from 5.8% for colorectal cancer to 11% in patients with lung or breast cancer. Radiotherapy was most commonly used in patients with lung cancer (18.7%) and least commonly used in those with pancreatic cancer (1.3%).

Compared with patients with private insurance, uninsured patients had 47% lower odds of surgery for their primary tumor for colorectal cancer and 14% lower odds of radiotherapy for lung cancer. Overall, across all cancer types, chemotherapy was much less commonly used in patients without insurance.

Patients who were treated for metastatic disease at a community cancer center were 40% less likely to undergo surgery for their primary tumor and 48% less likely to undergo radiation for lung cancer compared with those treated at a National Cancer Institute-designated cancer center.

Disclosure: Some of the authors disclosed ties to medical companies and the pharmaceutical industry. For a full list of disclosures, please refer to the original study.


  1. Sineshaw HM, Jemal DVMA, Ng K, et al. Treatment patterns among de-novo metastatic cancer patients who died within one month of diagnosis [published online April 15, 2019]. JNCI Cancer Spectr. doi: 10.1093/jncics/pkz021