Evaluating Survival Outcomes of Systemic Anti-cancer Therapy in Metastatic Cancer - EMJ

Evaluating Survival Outcomes of Systemic Anti-Cancer Therapy in Metastatic Cancer

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PATIENTS with metastatic or advanced cancer treated at practices administering more systemic anticancer therapy did not display significantly improved survival outcomes compared to patients treated at practices utilising less. The American Society of Clinical Oncology and the National Quality Forum (NQF) aim to reduce systemic anticancer therapy administration at the end of patient’s lives. A cancer quality control metric, NQF 0210, looked at the survival outcomes of patients receiving chemotherapy in the last 14 days of life. Researchers conducted a retrospective study on adult cancer patients treated at health care practices using the NQF 0210 metric to evaluate whether patients receiving higher rates of oncologic therapy for advanced disease experienced survival benefits.  

Researchers conducted a retrospective population-based cohort study, analysing data from 78,446 adult patients across the United States, focusing on six common metastatic solid tumours: breast cancer, colorectal cancer, non–small cell lung cancer, pancreatic cancer, renal cell carcinoma, and urothelial cancer. This study used the Flatiron Health de-identified electronic health record database, comprising patients treated at health care practices from 2015 to 2019. Practices were stratified into quintiles based on retrospectively measured rates of NQF 0210. Multivariable Cox proportional hazard models, adjusted with a Bonferroni correction for multiple comparisons, were used to compare overall survival by disease type among patients treated at each practice quintile from the time of diagnosis.   

Results revealed no statistically significant survival benefit for patients treated at practices with higher rates of systemic therapy for very advanced cancer. There were no significant differences in overall survival between the highest and lowest quintiles of NQF 0210 rates. The hazard ratios for death varied across cancer types, with renal cell carcinoma patients showing a hazard ratio of 0.74 (95% confidence interval [CI], 0.55-0.99) and urothelial cancer patients showing a hazard ratio of 1.41 (95% CI, 0.98-2.02), but these differences were not statistically significant. The results suggest that oncologic treatment at the end of life does not necessarily translate into improved survival outcomes. As a result, oncologists might reconsider the administration of additional systemic therapies for very advanced cancers and instead focus on transparent conversations with patients about prognosis. Moreover, helping oncologists identify when further therapy is futile could ensure that patients can make informed decisions, ultimately enhancing the quality of their end-of-life care. 


Canavan ME et al. Systemic anticancer therapy and overall survival in patients with very advanced solid tumors. JAMA Oncol. 2024;DOI:10.1001/jamaoncol.2024.1129 

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