The rate of surgical resection of the primary tumor in metastatic breast cancer has declined in recent years, possibly due to changes in practice after random, controlled trials that have not consistently demonstrated a benefit in survival.
Sasha Douglas, MD presented the study ( abstract HTML7-06 ) at the 2021 San Antonio Breast Cancer Symposium. Douglas, an oncologist at the University of California San Diego and a resident surgeon at the University of California San Diego, stated, “Intuitively you would think that it is beneficial to remove the primary tumor even the case that it has metastasized.”
Clinical trials have yielded mixed results. This is due to the many molecular subtypes as well as metastatic sites of breast cancer. “Retrospective studies and large databases with a large number of patients can provide different results than smaller prospective randomized controlled studies that are conducted in a different patient cohort. So, we just thought it would be really interesting to examine the patterns in the past at hospitals accredited by the Commission on Cancer. Do they appear to be following what the most recent research is showing?” Douglas said in an interview.
The researchers used data from 87.331 cases from the National Cancer Database (NCDB) and examined rates of primary surgery as well as palliative care for women suffering from metastatic breast cancer who had responded well to systemic therapy.
Between 2004 and 2009, rate of primary tumor removals was at 35%. This reached a peak of 37 percent in 2009. Then it began to drop to 18% by the year 2017. The researchers found similar trends in estrogen receptor-positive/progesterone receptor-positive, HER2-negative (ER/PR+HERer2-); HER2-positive; and triple-negative subtypes.
In 2004, 48% of patients received only systemic therapy, while 37% received some combination of surgery and radiation to the primary tumor. In 2019, 69 percent of patients received systemic therapy, and 20% received locoregional treatments ( P.001). Douglas stated, “It seems like surgeons, providers, and medical oncologists have become more selective in who they’ll provide surgery to. I think that’s very right.”
Another finding indicates that there is room for improvement. Just 21% of patients received palliative treatment. “I think that everybody suffering from a serious illness like this could benefit from palliative care, just on a supportive basis. The palliative care team could really assist people in improving their quality of life, but I think it still has that stigma and this is what we’ve observed from our study,” said Douglas.
“We’re just making up our minds, butsome of that could be from the stigma of thinking that palliative care means giving up. It’s not necessarily the case. It means you’re dealing with an extremely chronic illness and [palliative care] can be extremely, very beneficial for patients,” said Douglas.
The retrospective nature of the study restricts the scope of the study. Palliative care could not be reported in NCDB.
The National Cancer Institute and University of California, San Diego funded the study. Douglas has no financial disclosures.
This article was first published on MDedge.com. It is part of the Medscape Professional Network.
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