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Survival among patients with untreated metastatic breast cancer: “What if I do nothing?”

  • Epidemiology
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Abstract

Purpose

We sought to assess survival outcomes of patients with de novo metastatic breast cancer (dnMBC) who did not receive treatment irrespective of the reason.

Methods

Adults with dnMBC were selected from the NCDB (2010–2016) and stratified based on receipt of treatment (treated = received at least one treatment and untreated = received no treatments). Overall survival (OS) was estimated using the Kaplan–Meier method, and groups were compared. Cox proportional hazards models were used to identify factors associated with OS.

Results

Of the 53,240 patients with dnMBC, 92.1% received at least one treatment (treated), and 7.9% had no documented treatments, irrespective of the reason (untreated). Untreated patients were more likely to be older (median 68 y vs 61 y, p < 0.001), have higher comorbidity scores (p < 0.001), have triple-negative disease (17.8% vs 12.6%), and a higher disease burden (≥ 2 metastatic sites: 38.2% untreated vs 29.2% treated, p < 0.001). The median unadjusted OS in the untreated subgroup was 2.5 mo versus 36.4 mo in the treated subgroup (p < 0.001). After adjustment, variables associated with a worse OS in the untreated cohort included older age, higher comorbidity scores, higher tumor grade, and triple-negative (vs HR + /HER2-) subtype (all p < 0.05), while the number of metastatic sites was not associated with survival.

Conclusions

Patients with dnMBC who do not receive treatment are more likely to be older, present with comorbid conditions, and have clinically aggressive disease. Similar to those who do receive treatment, survival in an untreated population is associated with select patient and disease characteristics. However, the prognosis for untreated dnMBC is dismal.

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Data availability

All data used for this study are from the National Cancer Data Base, which is freely available to hospitals with CoC status.

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

Dr. Plichta is supported by the National Institutes of Health Office of Women’s Research Building Interdisciplinary Research Careers in Women’s Health K12AR084231 (PI: Amundsen). This work was in part supported by Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan) for the Biostatistics Core.

Author information

Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA

    Jennifer K. Plichta & E. Shelley Hwang

  2. Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA

    Jennifer K. Plichta

  3. Duke Cancer Institute, Durham, NC, USA

    Jennifer K. Plichta, Samantha M. Thomas, Susan G. R. McDuff, Gretchen Kimmick & E. Shelley Hwang

  4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Samantha M. Thomas

  5. Department of Surgery, Loyola University Medical Center, Maywood, IL, USA

    Xuanji Wang

  6. Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

    Susan G. R. McDuff

  7. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Gretchen Kimmick

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Contributions

Jennifer K. Plichta helped in conceptualization, methodology, data analysis, writing (original draft, review, and editing), and project administration. Samantha Thomas helped in methodology, resources, data curation, formal analysis, and writing (review and editing). Xuanji Wang worked in data review and writing (original draft, review, and editing). Sarah Sammons worked in data analysis and writing (review and editing). Susan McDuff worked in data analysis and writing (review and editing). Gretchen Kimmick worked in data analysis and writing (review and editing). E. Shelley Hwang worked in resources, data analysis, writing (review, and editing), and project administration.

Corresponding author

Correspondence to Jennifer K. Plichta.

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Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. J. Plichta is a recipient of research funding by the Color Foundation and Earlier.org (PI: Plichta), unrelated to the submitted work. JP serves on the Editorial Committee for the American Joint Committee on Cancer (AJCC), Breast Cancer panel for the AJCC, and the National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnosis panel. JP is on the editorial board for the journal (Breast Cancer Research and Treatment), but she was not involved in the editorial process for this manuscript. Dr. E.S. Hwang serves on the NCCN Breast Cancer Risk Reduction panel. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Plichta, J.K., Thomas, S.M., Wang, X. et al. Survival among patients with untreated metastatic breast cancer: “What if I do nothing?”. Breast Cancer Res Treat 205, 333–347 (2024). https://doi.org/10.1007/s10549-024-07265-2

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