Julio Aguirre-Ghiso, Professor of Cell Biology at Albert Einstein College of Medicine, shared a post on LinkedIn:
“1– Are 90% of cancer-related deaths due to metastasis? Apparently the overuse of this percentage in reviews has created confusion and questioning of whether this is true. The answer, which is as always cancer type dependent, may be in these references that also people claim they cannot find.
Title: Are 90% of deaths from cancer caused by metastases?
Authors: Hanna Dillekås, Michael S Rogers, Oddbjørn Straume
Read further on PubMed.
Title: Causes of death among people living with metastatic cancer
Authors: Kyle Mani, Daxuan Deng, Christine Lin, Ming Wang, Melinda L Hsu, Nicholas G Zaorsky
Read further on PubMed.
Title: Patterns of de novo metastasis and survival outcomes by age in breast cancer patients: a SEER population-based study
Authors: Ian Xiao, Weixiao Zhang, Jingfeng Jing, Tingting Zhong, Daxue Li, Jing Zhou, Pan Liu, Zhongxu Duan, Han Gao, Liyuan Shen
Read further on Fronties.
The answer is that, yes, majority of the deaths are metastasis-linked.
2– Then people ask, do the metastases directly kill the patient, or is it a bystander effect of the metastasis? The answer has been expertly covered by:
Title: Roadmap: Why do patients with cancer die?
Authors: Adrienne Boire, Katy Burke, Thomas Cox, Theresa Guise, Mariam Jamal-Hanjani, Tobias Janowitz, Rosandra Kaplan, Rebecca Lee, Charles Swanton, Matthew G Vander Heiden, Erik Sahai
Read further on PubMed.
3-What is the actual source of metastatic lethality?
Organ failure, obstruction (directly by metastasis), cachexia, bleeding, infection, paraneoplastic syndromes and are considered “cancer (metastasis)-specific” causes of death. In melanoma these have been measured:
Title: Causes of death and patterns of metastatic disease at the end of life for patients with advanced melanoma in the immunotherapy era.
Authors: Daniel Lee, Alexander Yang, Madeline McNamara, Harriet M Kluger, Thuy Tran, Kelly Olino, James Clune, Mario Sznol, Jeffrey Joseph Ishizuka
Read further on Journal of Clinical Oncology
4-One could also ask: how many patients that have metastasis die due to causes not related to metastasis? In a large US registry-based study 82.6% of patients with metastatic cancer die from cancer, while 17.4% die from non-cancer causes.
Title: Causes of Death Among People Living With Metastatic Cancer
Authors: Kyle Mani, Daxuan Deng, Christine Lin, Ming Wang, Melinda L. Hsu, Nicholas G. Zaorsky
Read the full article on nature communications.
5-In patient with bone metastasis across all cancers, death unrelated to metastasis was 5.9%.
So majority of deaths are cancer metastasis linked.
Title: Comprehensive analysis of cancer and non-cancer mortality in patients with bone metastases: A population-based study
Authors: Xia Yan, Hongyu Liu, Xueqi Bai, Jin Xu, Xiaojun Lou, Lai Wang
6-These data lead to the question, what do we need to focus on to change survival?
Targeting metastasis early before they start to cause all the problems mentioned above or intervene the actual consequences of metastasis.
Maybe both?.
7–But acting early is key.
Managing late-stage metastatic symptoms is necessary but will likely offer only marginal survival gains.
Treatments moved from stage IV to the adjuvant phase have revolutionized outcomes (Trastuzumab, Pembrolizumab, Osimertinib & combinations like Dabrafenib & Trametinib)
8-Management of metastasis-related lethality should expand from metastasis/recurrence treatment to metastasis prevention (earlier interception/treatments) and learn from the experience in cancer prevention.
A new mindset and technology expansion is needed for this.”
Title: Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020.
Authors: Katrina A. B. Goddard, Eric J. Feuer, Jeanne S. Mandelblatt, Rafael Meza, Theodore R. Holford, Jihyoun Jeon, Iris Lansdorp-Vogelaar, Roman Gulati, Natasha K. Stout, Nadia Howlader, Amy B. Knudsen, Daniel Miller, Jennifer L. Caswell-Jin, Clyde B. Schechter, Ruth Etzioni, Amy Trentham-Dietz, Allison W. Kurian, Sylvia K. Plevritis, John M. Hampton, Sarah Stein, Liyang P. Sun, Asad Umar, Philip E. Castle
Read the full article on Jama Network.
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