The survival of patients with metastatic cancer has increased slightly in most tumor types over the past three decades. This has emerged from a study by Marianne Luyendijk (IKNL) and colleagues. More than eighty new drugs were introduced during the study period and survival in solid tumors was examined. Overall, the researchers saw a modest increase in survival, which varies greatly by tumor type.
In addition to improving treatments, the study points to the importance of prevention and early detection of cancer in order to reduce the number of patients with metastatic cancer. The results are based on figures from the Dutch Cancer Registry (NKR) and published in the Journal of the National Cancer Institute (JNCI). In the study, the researchers evaluated the 1- and 5-year survival of patients whose cancer had spread at diagnosis, and divided it into two periods, namely 1989-1993 and 2014-2018.
Increase or decrease in 1-year survival, by tumor type, between 1989-1993 and 2014-2018 for cancer that had metastasized at diagnosis. For breast cancer, for example, the 5-year survival has increased by 18 percent from 14 to 32 percent.
Uit de studie blijkt dat bij patiënten met een gastro-intestinale stromatumor (GIST) of een neuro-endocriene tumor – twee zeldzame vormen van kanker in het maagdarmkanaal- de overleving het sterkst is toegenomen. Onderzoeker Marianne Luyendijk: ’Deze grote toename hangt samen met de introductie van geneesmiddelen die bij deze vormen van kanker zeer effectief zijn, zoals het middel imatinib (geïntroduceerd in 2002) voor GIST.’
The 5-year survival rate for non-small cell lung cancer was 1 percent 30 years ago. In the most recent survey period of this study, it was 7 percent. Survival of other common cancers, such as prostate, colon, and breast, also increased slightly.
New medicines
Although more than eighty new drugs have been introduced since the 1990s and treatment options for patients with metastatic cancer have expanded, achieving survival gains remains a challenge. Prof. Dr. Sabine Siesling (IKNL/ University of Twente): 'If we look at the figures of patients diagnosed up to and including 2018, the survival gain seems limited. Fortunately, a lot of progress has been made for certain subgroups. And sometimes the treatment is not primarily aimed at prolonging life, but at reducing complaints.'
Changes in 5-year survival between the period 1989-1993 and 2014-2018, by tumor type, in relation to the number of drugs introduced. For breast cancer, for example, the 5-year survival increased by 18 percent, in a period when 17 new drugs were introduced.
In the study, the researchers looked at general trends and developments, and not at a direct relationship between drugs and outcomes. Knowing how effective a drug is requires more data than has been used in this study. Siesling: 'These historical data indicate that the results found in trials are not always achieved in daily practice. In order to study the effectiveness, we also have to map out at an individual level which patient has received a certain medicine, when a medicine was administered and in what quantity. It is at least as important to look at which side effects occurred, to what extent they influenced the use of the medicine and the quality of life of the patient. What choice did the doctor and patient make? What effect will new drugs introduced after 2018 have? Accurate monitoring of patients who are currently being treated in daily practice is necessary to see what effects drugs have outside of a trial context. These are relevant issues that we look at in other studies. Given the rising prices of new medicines, it is also important that cost-effectiveness is also taken into account. The limited survival also underlines the importance of good care in the palliative phase.'
Researchers from IKNL, University of Twente, Erasmus University Rotterdam, UMC Groningen, –Antoni van Leeuwenhoek, Maastro / Maastricht University and Catharina hospital collaborated in the study.
In one in five patients with cancer, the cancer has already spread at the time of diagnosis. Half of the patients whose cancer has already spread at diagnosis live six months or less after diagnosis. That is only one month longer compared to 10 years ago, according to the report 'Metastatic cancer in the picture', which IKNL published in 2020. The report contains an extensive overview of localizations per tumor type and recommendations for care in oncology and in the palliative phase.
