Future trends in incidence and long-term survival of metastatic cancer in the United States

Nicholas L Hudock; Kyle Mani; Chachrit Khunsriraksakul; Vonn Walter; Larissa Nekhlyudov; Ming Wang; Eric J Lehrer; Maria R Hudock; Dajiang J Liu; Daniel E Spratt; Nicholas G Zaorsky

doi:10.1038/s43856-023-00304-x

Future trends in incidence and long-term survival of metastatic cancer in the United States

Commun Med (Lond). 2023 May 27;3(1):76. doi: 10.1038/s43856-023-00304-x.

Authors

Nicholas L Hudock^{1

2}, Kyle Mani³, Chachrit Khunsriraksakul^{1

2

4}, Vonn Walter⁵, Larissa Nekhlyudov⁶, Ming Wang⁷, Eric J Lehrer⁸, Maria R Hudock^{9

10}, Dajiang J Liu^{4

5}, Daniel E Spratt¹¹, Nicholas G Zaorsky¹²

Affiliations

¹ Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.
² Penn State College of Medicine, Hershey, PA, USA.
³ Albert Einstein School of Medicine, Bronx, NY, USA.
⁴ Department of Bioinformatics and Genomics, Penn State College of Medicine, Hershey, PA, USA.
⁵ Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
⁶ Department of Internal Medicine, Harvard Medical School, Boston, MA, USA.
⁷ Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
⁸ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Biomedical Engineering, Columbia University, New York City, NY, USA.
¹⁰ Vagelos College of Physicians & Surgeons, Columbia University, New York City, NY, USA.
¹¹ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
¹² Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA. nicholaszaorsky@gmail.com.

Abstract

Background: Previous studies have demonstrated epidemiological trends in individual metastatic cancer subtypes; however, research forecasting long-term incidence trends and projected survivorship of metastatic cancers is lacking. We assess the burden of metastatic cancer to 2040 by (1) characterizing past, current, and forecasted incidence trends, and (2) estimating odds of long-term (5-year) survivorship.

Methods: This retrospective, serial cross-sectional, population-based study used registry data from the Surveillance, Epidemiology, and End Results (SEER 9) database. Average annual percentage change (AAPC) was calculated to describe cancer incidence trends from 1988 to 2018. Autoregressive integrating moving average (ARIMA) models were used to forecast the distribution of primary metastatic cancer and metastatic cancer to specific sites from 2019 to 2040 and JoinPoint models were fitted to estimate mean projected annual percentage change (APC).

Results: The average annual percent change (AAPC) in incidence of metastatic cancer decreased by 0.80 per 100,000 individuals (1988-2018) and we forecast an APC decrease by 0.70 per 100,000 individuals (2018-2040). Analyses predict a decrease in metastases to liver (APC = -3.40, 95% CI [-3.50, -3.30]), lung (APC (2019-2030) = -1.90, 95% CI [-2.90, -1.00]); (2030-2040) = -3.70, 95% CI [-4.60, -2.80]), bone (APC = -4.00, 95% CI [-4.30, -3.70]), and brain (APC = -2.30, 95% CI [-2.60, -2.00]). By 2040, patients with metastatic cancer are predicted to have 46.7% greater odds of long-term survivorship, driven by increasing plurality of patients with more indolent forms of metastatic disease.

Conclusions: By 2040, the distribution of metastatic cancer patients is predicted to shift in predominance from invariably fatal to indolent cancers subtypes. Continued research on metastatic cancers is important to guide health policy and clinical intervention efforts, and direct allocations of healthcare resources.

Plain language summary

Cancer that has spread beyond the area where it originated and into different organs is called metastatic cancer. This study analyzed trends in metastatic cancer incidence, the proportion of those with metastatic cancer surviving 5 years after diagnosis and the locations in the body each cancer had spread to. The incidence of metastatic cancer decreased between 1988 and 2018 and is expected to continue to decrease until 2040. Some of the most common locations cancer spreads to is the lung, liver, brain, and bone. Metastatic cancer incidence to these areas is predicted to decrease. Also, the likelihood of surviving for more than 5 years after diagnosis with metastatic cancer is predicted to increase by 2040. This research should facilitate optimal planning of future healthcare resources and policy.