The report highlights the increasing use of targeted therapies before surgery to treat cancer

Breast, bladder and pancreatic cancers are increasingly being treated with a wide range of therapies before a patient undergoes surgery, and the stage of cancer at the time of diagnosis remains a critical factor in determining a person’s survival rate for all cancers, says the first study All Annual Cancer Report from the National Cancer Database (NCDB) of the American College of Surgeons (ACS) cancer programs.

The results were published this week in the Journal of the American College of Surgeons (JACS).

The NCDB, a clinical oncology database jointly operated by the ACS and the American Cancer Society, collects hospital data on approximately 74% of all cancers diagnosed in the United States and is one of the most comprehensive cancer research databases.

This report is our approach to making NCDB data more widely available to others who may benefit from understanding this large source of cancer data and what it tells us about the current state of cancer diagnoses and treatment in the United States. “

Elizabeth B. Habermann, MPH, PhD, first author, chair of the ACS Cancer Data Modeling Committee and professor of health services research at the Mayo Clinic in Rochester, Minnesota

The report summarizes new observations and current trends in cancer diagnoses and contains many details not typically included in other cancer reports, the authors said. Unique metrics captured in the NCDB data include length of stay, hospital readmission rates, and hospital type (e.g., community or academic institution). These metrics help hospitals assess the quality of care and inform treatment options for the growing number of cancer patients across the country, the authors added.

The report focuses on 2021, the then most recent data available from the NCDB, and overall cancer trends from 2004 to 2021.

Main results

• More and more types of cancer are being treated with targeted medical therapies before surgery: The use of neoadjuvant systemic therapy, typically given to patients before surgery or other primary cancer treatment, has increased in breast, bladder, and pancreatic cancers, while it remains low in other cancers. Systemic therapies include a wide range of treatment options, including hormone therapy, immunotherapy and chemotherapy, aimed at reaching cells throughout the body to hopefully shrink an existing tumor and prevent it from spreading further. According to the report, the use of neoadjuvant systemic therapy, particularly hormone therapy, for breast cancer at Commission on Cancer (CoC) accredited sites increased from 11% in 2010 to 18% in 2021. Also for pancreatic cancer (increase of 224%) and urinary bladder cancer There have been significant increases in neoadjuvant therapy since 2010 (increase of 102%) systematic therapy identified.

  Although there was a slight decrease in the use of systemic neoadjuvant therapy in some cancer types in 2021 due to the pandemic, these trends suggest a continued increase in the use of neoadjuvant systemic therapy in certain cancer types, according to the authors.

  “One of the goals of neoadjuvant systemic therapy is to treat the cancer beforehand to hopefully reduce the size of the tumor and/or lymph node involvement so that less extensive surgery can be performed,” said Judy C. Boughey, MD, FACS, senior Author of JACS Study and Chair of the ACS Cancer Research Program.

  Dr. Boughey, who also serves as division chief of surgical breast and melanoma oncology at the Mayo Clinic in Rochester, Minnesota, added that neoadjuvant systemic therapy may also serve as the basis for recommendations for other cancer therapies after surgery, depending on how a patient’s tumor responds to the treatment received.

• Previous cancer saves lives: Across all cancer types, patients with early-stage cancers (precancer or stage I-II) had the best outcomes and 5-year survival rates. Although not a new finding, the authors say this finding confirms that screening and early detection continue to be essential factors for patients diagnosed with cancer.
• Women perform better than men: In total The five-year survival rate for all cancers was 64% in 2021. When stratified by gender, women had a significantly better 5-year overall survival rate (68%) than men (59%) for all cancers analyzed in the report.

The report also describes detailed data on three specific cancer types: breast, colon and pancreas. The team chose these cancers because of their unique characteristics: colorectal and breast cancer are commonly diagnosed and treated with different types of surgery; Pancreatic cancer is also treated surgically, but is less common and has a very low survival rate.

• Early-stage breast cancer is increasing: From 2004 to 2021, approximately 21% more women were diagnosed with early-stage (stage I) breast cancer, while the overall rate of advanced-stage (stage IV) diagnoses decreased by approximately 28%. Most patients who underwent breast surgery had a lumpectomy (66%), and the majority of these women (81%) were also treated with radiation therapy. The use of hormone therapy more than doubled from 3.3% in 2018 to 7.7% in 2020.

  According to the report, breast cancer, which was among the most common cancers diagnosed at CHC sites, also had one of the highest survival rates compared to other cancers, particularly among women diagnosed with early-stage breast cancer. Women diagnosed with stage I breast cancer have a 5-year survival rate of approximately 93%.

• Colorectal cancer is most often diagnosed in later stages: Nationwide, colon cancer rates are increasing among younger populations. The NCDB report found that colorectal cancer is one of the most commonly diagnosed solid organ cancers in both men and women, diagnosed at an average age of 68. Patients were most commonly diagnosed with stage II or III colon cancer. About 81% of patients diagnosed with colon cancer underwent colectomy, a surgery that removes all or part of the colon. Stage at diagnosis remains the most important factor in long-term overall survival, with patients with stage IV colon cancer having a 5-year survival rate of about 19%, compared to about 82% for stage I or 72% for colon cancer, according to the NCDB report in stage II.
• Pancreatic cancer is often discovered too late: Pancreatic cancer continues to be diagnosed at later stages when patient outcomes are worse; Nearly half of patients had stage IV disease at diagnosis, although the NCDB report found a steady increase in patients diagnosed with stage I pancreatic cancer over the past two decades (from about 10% in 2004 to about 28% in 2021). There are currently no consistent guidelines for early detection of pancreatic cancer, and symptoms often do not appear until the cancer has spread, making treatment difficult. Patients with pancreatic cancer are usually older (average age 70 years) and the disease is slightly more common in men. However, the NCDB report also noted some encouraging trends in pancreatic cancer treatment options: More patients with pancreatic cancer are being treated with chemotherapy and other therapies before surgery, with the use of neoadjuvant systemic therapy increasing by more than 200% from 2010 to 2010 2021.

The ACS Cancer Data Modeling Committee plans to publish annual cancer reports focusing on general cancer trends as well as detailed data on three different cancer types selected based on volume and/or mortality rate.

“The CoC is dedicated to improving care for all cancer patients. The CoC standards and quality metrics were developed by multidisciplinary experts for each cancer type and are based on evidence-based research,” said Ronald J. Weigel, MD, PhD, MBA, FACS, medical director of the ACS Cancer Programs and co-author of the JACS Study. “Comprehensive data sets like the National Cancer Database are essential to better inform research and help us advance cancer treatment.”

Co-authors of the study JACS Reporting are Courtney N. Day, MS; Bryan E. Palis, MA; Jennifer K. Plichta, MD, FACS; and Nabil Wasif, MD, FACS.