Prevalence and characteristics of patients with stage IV solid tumors who receive no anticancer therapy.

Health Services Research
Session Type and Session Title: 
General Poster Session, Health Services Research
Abstract Number: 


J Clin Oncol 30, 2012 (suppl; abstr 6065)
Alexander C. Small, Che-Kai Tsao, Erin L. Moshier, Benjamin Adam Gartrell, Juan P. Wisnivesky, James H. Godbold, Cardinale B. Smith, Guru Sonpavde, William K. Oh, Matt D. Galsky; Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY; Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY; Texas Oncology, Houston, TX, and Department of Medicine, Section of Medical Oncology, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX

Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures


Background: Clinicians caring for patients with cancer are well aware that a subset of patients who present with metastatic solid tumors never receive anticancer therapy for reasons including poor functional status, comorbidities, and patient preference. The prevalence and characteristics of this population have not previously been described. Methods: The National Cancer Database was queried for patients diagnosed with metastatic (stage IV) solid tumors including breast, cervix, colon, kidney, small-cell and non-small cell lung [NSCLC and SCLC], prostate, rectum and uterus. Patients who received neither radiation therapy nor systemic therapy were identified. Other factors such as age, race, income, insurance status, and diagnosis year were assessed. In an exploratory analysis, log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of untreated stage IV to treated stage IV cancer cases according to these factors. Results: From 2000-2008, 773,233 patients with stage IV cancer were identified of whom 159,284 (21%) received no anticancer therapy (Table). Patients with NSCLC accounted for 55% of untreated patients. Across all cancer types, older age (PR range 1.37-1.49, all p<0.001), black race (PR range 1.05-1.32, all p<0.001), lack of medical insurance (PR range 1.47-2.46, all p<0.001), and lower income (except uterus) (PR range 0.91-0.98 for every $10,000 income, all p<0.001) were associated with increased prevalence of not receiving treatment. Conclusions: Approximately 20% of patients who present with stage IV solid tumors never receive anticancer therapy. These findings have potential implications with regards to healthcare policy and access to care.
Prevalence of patients with metastatic cancer who receive no anticancer therapy (2000-2008).
Cancer Type Untreated
stage IV
stage IV
% untreated Cancer-specific
% of total
untreated cases
Kidney 12,079 47,417 25.5% 7.6%
NSCLC 87,400 353,748 24.7% 54.9%
Uterus 297 1,217 24.4% 0.2%
SCLC 21,085 99,206 21.3% 13.2%
Rectum 4,305 26,140 16.5% 2.7%
Colon 18,816 119,748 15.7% 11.8%
Cervix 1,407 9,535 14.8% 0.9%
Breast 7,313 57,148 12.8% 4.6%
Prostate 6,582 59,074 11.1% 4.1%
Total 159,284 773,233 20.6% 100.0%