Note: Trends in the use of adjuvant therapy for melanoma, ovarian, prostate and head and neck cancer will be available in late 2008.
Cancer treatment is improving—saving lives and extending survival for people with cancers at many sites, including breast and colon, and for people with leukemias, lymphomas, and pediatric cancers.
Clinical trials are the major avenue for discovering, developing, and evaluating new therapies. However, a relatively small percentage of all adult cancer patients (20 years and older) participate in clinical trials; the exact percentage is unknown because NCI-sponsored trials and industry-sponsored trials are tracked separately. It is important to increase physician and patient awareness of, and participation in, clinical trials if we are to test new treatments more rapidly, find more effective treatments, and broaden the options available to patients.
For treatments already in use, trends in patterns of care have been examined for major cancers including breast, colorectal, prostate, and ovarian cancers. Patterns of care at specific points in time, generally in relationship to the release of new guidance on care, have been documented for additional cancers, including bladder, cervical, endometrial, head and neck, non-Hodgkin Lymphoma, and melanoma. These studies have been supported through the NCI Patterns of Care/Quality of Care and Surveillance, Epidemiology, and End-Results (SEER)-Medicare projects.
Research results on breast cancer treatment have shown that the use of breast-conserving surgery increased markedly over the period 1992 - 2002. However, between 1998 and 2002 the proportion of women receiving breast-conserving surgery who also received radiation treatment declined modestly. The use of recommended adjuvant chemo- and hormonal therapy increased substantially between 1987 and 1995. Similarly, the receipt of adjuvant chemotherapy for stage III colon cancer increased markedly following the publication in 1989 of clinical recommendations for this treatment.
The studies also show that older individuals and members of racial-ethnic minority groups are less likely to receive these treatments. More investigation is required to determine if these differences in treatments received constitute disparities in quality of care that need to be addressed through policy or organizational interventions. In addition, some of these differences have decreased over time; for example, the treatment gap between White and Black patients with stage III colon cancer closed between 1995 and 2000.
NCI is working with many Federal and private partners to improve methods and data systems for tracking the quality of cancer care. For prostate cancer, a major study on quality-of-life outcomes among 3,500 men following diagnosis has provided important new information that will help men and their families and physicians to make more informed decisions about treatment. An ongoing NCI study, the Cancer Care Outcomes Research and Surveillance Consortium, will provide more detailed information on how to link quality-of-care measures to outcomes important to colorectal and lung cancer patients. Other, similar initiatives are being supported by major professional organizations, as well as by NCI.
These and other ongoing studies will provide much new information on treatment. Future editions of the Cancer Trends Progress Report will include treatment trends for cancer sites for which there are definitive treatment guidelines based on rigorous evidence of benefit to patients.