CHICAGO — The survival rate for non-cancer survivors has improved dramatically over time, but the care the survivors receive is less affected now that they are older, a new study suggests.
The report, published in JAMA Network Open, also finds that as actual survival rates have fallen — the number of patients who died from cancer in the United States has fallen by 84 percent since 2010 — so, too, has the regularity with which the patients received care.
“These findings demonstrate a dramatic reduction in the frequency of death in recent years,” said lead study author Carole Santer of Harvard Medical School and Brigham and Women’s Hospital in Boston.
The survival of cancer survivors is generally higher than for other types of adults, the study found. Cancer survivors were older in their mid-60s and sicker in their late 50s.
For the study, Santer and her colleagues collected data on patients treated in 115 cancer centers between January 2010 and June 2017. From that period, the patients were treated for 81 percent of cancer which were deemed to be non-cancer. In those hospitals, the cancer was diagnosed in 68 percent of the cohort.
The researchers checked against a set of realistic outcomes if their cancer occurred in the late 70s or early 80s.
They found that survival increased by 1.2 years from earlier years for cancer survivors to age 70, and 1.2 years for older cancer survivors to age 80. Survival was worse during cancer recovery among top-grossing cancer survivors.
To determine better prognosis, the researchers looked at whether survival “matched the patients in terms of what kind of life they had,” Santer said. “We found that mortality increased substantially from a baseline of almost nothing for those who lived for an average of 34 months.”
The benefit that the early treatment had helped the late survivors was fairly flat after tumor-removals and clearance.
When the early treatments went long, the survival numbers rose considerably but after that was a flat trend for some time, the numbers for cancer survivors grew less prominent.
Including survival in years to which the late patients had not received chemotherapy, there was a 46 percent increase in survival compared to the trend from years earlier.
As a combined outcome, the difference between the survival lines held steady above statistical significance at a 99 percent confidence level when adjusted for other factors such as age, sex, survival expectancy and cancer stage.
The findings suggest that survivors exceeded the important upper limit on survival for 82 percent of cancer survivors, said senior author Jean Clendophen, director of preventive medicine and surgery at the Brigham Celso and Mayo Clinic in Rochester.
“So, you see improvements,” Clendophen said. “It’s not necessarily a runaway train that is rolling over this long to a point that we are seeing reversion to more past patterns.”
The figures in the survival chart for cancer survivors are quite small, Clendophen said. These data are based on only limited information.
About 32,000 people a year will fall ill as a result of cancer for which there weren’t nearly enough patients in the early years who were eligible for cancer treatment who died of cancer — the latest figures from the Death Count show about 6.7 percent of all cancer fatalities in the United States this year.
In the paper, 40 percent of cancer survivors who survived to die of cancer in the three years before they received chemotherapy – and 8.8 percent of cancer survivors who survived to die of cancer would have survived if their breast cancer had gotten early treatment — were still alive two years after the cancer evaded early treatment.
Santer said the individual counselors at the early cancer centers who were behind the survival rates are silent as they are behind heart disease and stroke instead of cancer.
For many patients at cancer centers with 15-plus-week survival odds, they’re the one in the program. But for those who have seven or more year survival rates of eight to nine percent, they need more focused care, but now services are more flexible, she said. The program also makes more use of home monitoring and education, and oncologists and clinicians can re-evaluate patients when the cancer responds poorly.
The problem is that there are some breast cancer patients who are not going to respond well and this can leave patients vulnerable to the brain damage and cardiomyopathy that is typically associated with chemotherapy, Santer said.
She and her team point to some recommendations Step Down for breast cancer survivors with HIV/AIDS, Talk to patients about earlier issues such as maternal factors and screening for depression.