The first annual report on cancer trends and outcomes from the National Cancer Database (NCDB), “ACS Cancer Programs Annual Report from 2021 Participant User File,” was published last month in the Journal of the American College of Surgeons (JACS).
The ACS Cancer Research Program developed this introductory report to broadly distribute the information available in the NCDB (a hospital-based registry jointly sponsored by the ACS and the American Cancer Society), including the overall number of cancer cases in its 2021 participant user file (PUF), the frequency of different cancers and patient demographic, tumor, socioeconomic, and geographic characteristics associated with the most common solid malignancies. Within the initial report, information was provided specific to breast, colon, and pancreatic cancer.
The clinically focused narrative of these reports leveraged the strength of the NCDB to examine changes in practice and patient survival across a continuum ranging from more common to rare diseases. In contrast to the Surveillance, Epidemiology, and End Results (SEER) Program Annual Report to the Nation on the Status of Cancer—where the focus on rates and incidence draws from the population-based design of its set of registries1—the NCDB annual reports will facilitate a more comprehensive view of how nearly 74% of cancer diagnoses are managed across 24% of all hospitals in the US.
Key metrics for quality improvement comprehensive of operative mortality, trends with in-patient stay, and how trends in first course treatment impact long-term outcomes stratified by biomarkers are all described in the report for its target audience. Clinicians and researchers may use the report to not only better understand trends, but also to generate broad hypotheses for topics of further investigation using the case-level PUF. The goal is for this to be the first of an ongoing series of reports describing the NCDB annual PUFs as they’re released while highlighting different disease sites and cancer populations with each publication.
Breast Cancer
Breast cancer is the most common malignancy among women in the US. The NCDB captures 81.9% of breast malignancies with 264,095 adult cases of newly diagnosed breast cancer identified in 2021. Since diagnosis year 2004, there has been an observed increase in early stage disease and slightly less advanced/metastatic disease, attributable to age-sensitive changes with mammograms and screening guidelines.
The NCDB annual breast cancer report demonstrated that diagnoses made during 2018–2021 had a median age of 63, 99.2% women, with 74.8% identified as White. The insurance status of these breast cancer patients who visited a Commission on Cancer (CoC)-accredited hospital comprised of 47.5% of patients privately insured with only 6.8% on Medicaid, highlighting that differences in socioeconomic status may exist between accredited and nonaccredited hospitals.
Neoadjuvant systemic therapy has increased in use for early stage breast cancer. The use of neoadjuvant endocrine therapy has been shown to improve breast-conserving surgery rates in patients with ER+/HER2- breast cancer. Use of neoadjuvant endocrine therapy more than doubled from 3.3% and 3.6% prior to the pandemic to 7.7% in 2020. It also remained higher than baseline at 5.0% in 2021.
In patients who underwent mastectomy, the median inpatient stay was 24 hours between 2018 and 2021. Breast cancer generally has high survival rates, which is especially accurate in patients diagnosed with early stage and ER+/HER2- status.
Colon Cancer
Colon cancer impacts fewer than 30 in 100,000 men and women in the US.2 While more common in older adults, individual risk factors may influence age at diagnosis.2 The NCDB captures 73% of all newly diagnosed colon cancers, and in 2021, case details from 70,774 adult cases were collected.
This malignancy impacts both men and women equally, with most patients being diagnosed with stage II or III. There was a decrease in stage I diagnoses between 2004 (24%) and 2021 (20%) with a corresponding increase in stage IV disease during the same period, from 21% to 26%.
The 30-day operative mortality rate was 3.3%, with planned and unplanned readmission rates at 5.3% in 2021. Colon cancer was most commonly grade II (68.1%). Biomarker status remained stable from 2018 to 2021 and included microsatellite instability (MSI) stable (77.8%), Kirsten rat sarcoma (KRAS) abnormal (43.3%), and carcinoembryonic antigen (CEA) positive (51.6%). Long-term 60-month survival rates were highest for stage I (>80%), KRAS normal (>40%), CEA negative (>70%), unstable high disease MSI (>65%).
Pancreatic Cancer
Pancreatic cancer is relatively rare, affecting 13 out of 100,000 persons3 and accounting for 3% of all cancers and 7% of all cancer deaths.4 In 2021, the NCDB collected data on 40,817 adult cases of newly diagnosed primary pancreatic cancer, representing 76.4% of all pancreatic cancers diagnosed in the US. The mean age of pancreatic diagnoses in 2021 was 70, with slight male predominance (51.9%). Nearly half of all diagnoses from 2021 were still stage IV.
However, there was an increase in stage I disease noted between 2004 (9%) and 2021 (28%). The use of chemotherapy in stage I tumors increased between 2017 and 2021, by nearly 10%. The median inpatient stay after surgery was 6 days in 2021, with planned and unplanned readmissions at 7.5%. Thirty-day operative mortality rates are 2.3%. Grade I and neuroendocrine tumors had the highest observed 60- month survival rates at approximately 64% and 53%, respectively.
The findings presented in this article represent only a select portion of the information presented in this first NCDB annual report. Future reports will be released from each NCDB PUF and broadly focus on topics of contemporary practice guidelines, trends and outcomes with rare and common malignancies, and in different populations.
These reports will provide broader access to aggregate findings from the more than 80 disease sites captured in the NCDB, leveraging the clinical detail from accredited hospitals of the CoC, enhancing understanding of the most recent state of cancer diagnoses and care in the US.
Dr. Elizabeth Habermann is a professor of health services research at the Mayo Clinic in Rochester, MN, where she also serves as deputy director of research in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Robert D. and Patricia E. Kern Scientific Director of the center’s Surgical Outcomes Program. She is Chair of the ACS Cancer Data Modeling Committee.
References
- National Cancer Institute Surveillance, Epidemiology, and End Results Program Annual Report to the Nation on the Status of Cancer. Available at: https://seer.cancer.gov/report_to_nation/. Accessed on November 11, 2024.
- American Cancer Society. Key statistics for colorectal cancer. Available at: https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html. Accessed on October 3, 2024.
- American Cancer Society (2024). Key statistics for pancreatic cancer. Available at: https://www.cancer.org/cancer/types/pancreatic-cancer/about/key-statistics.html. Accessed on October 3, 2024.
- Kennedy J. How common is pancreatic cancer? Pancreatic Cancer Action Network. Available at: https://pancan.org/news/how-common-is-pancreatic-cancer/. Accessed on October 3, 2024.
