Causes of death among people living with metastatic cancer.
Level 3 - non-randomized controlled study
Retrospective population-based cohort study
PubMed 38374318 · doi:10.1038/s41467-024-45307-x
What was done
Authors analyzed causes of death among 1,030,937 US patients diagnosed with metastatic cancer between 1992 and 2019 across 13 cancer types and 25 non-cancer causes. They modeled the probability of dying from the primary cancer versus competing causes and built a Fine and Gray competing risk model to predict 1-year survival.
What was found
Of recorded deaths, 82.6% (n = 688,529) were due to the diagnosed cancer and 17.4% (n = 145,006) were due to competing causes. Median survival after metastatic diagnosis was 10 months. Lung, pancreas, esophagus, and stomach cancers had the highest likelihood of death from the primary cancer, whereas prostate and breast cancer had the lowest. The leading non-cancer causes of death were heart disease (32.4%), chronic obstructive pulmonary disease (7.9%), cerebrovascular disease (6.1%), and infection (4.1%). The Fine and Gray model predicted 1-year survival with an area under the receiver operating characteristic curve of 0.754 (95% CI [0.754, 0.754]).
Why it matters
Highlights that nearly one in six metastatic cancer patients dies from non-malignant conditions, emphasizing the need for comprehensive non-oncologic medical care in survivorship.
Limits
The study is restricted to 13 cancer types and relies on registry death certification data, which can carry misclassification bias. Specific cancer treatments, lifestyle factors, and baseline comorbidity severity were not described in the abstract.
Cited by
- contradicts About 50% of cancer deaths are caused by treatment-related complications rather than the cancer itself.