Landmark Cancer Report Reveals Surge in Pre-Surgical Medication & Focus on Esophageal Cancer
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A new analysis of over 22 million cancer cases highlights a growing trend toward utilizing medication—including chemotherapy, immunotherapy, and hormone therapy—before surgery, potentially leading to less invasive procedures and more effective treatment plans.
A comprehensive report released this week by the National Cancer Database (NCDB) of the American College of Surgeons (ACS) documents a substantial increase in the use of neoadjuvant systemic therapy – treatments administered via the bloodstream prior to surgical intervention. The findings, published in the Journal of the American College of Surgeons (JACS), suggest a paradigm shift in cancer care, moving away from immediate surgical removal of tumors toward a more nuanced, personalized approach.
The NCDB, a joint initiative of the ACS and the American Cancer Society, leverages data from nearly 75% of cancer cases across the United States, offering a uniquely detailed picture of the disease landscape. The current report analyzes cases diagnosed between 2004 and 2022, providing a long-term view of evolving treatment patterns.
“The NCDB report includes clinically relevant data intended to inform not only researchers but also the public on recent observations of cancer involving the latest treatment, surgical options, and cancer outcomes,” stated Ronald J. Weigel, MD, PhD, MBA, FACS, medical director of ACS Cancer Programs, and a co-author of the JACS study. “As care at CoC-accredited facilities continues to advance, our hope is that this report reflects the vastly changing clinical landscape of cancer treatments using the latest evidence-based treatments.”
Rise of Neoadjuvant Systemic Therapy
The report reveals significant increases in neoadjuvant systemic therapy across several cancer types. From 2010 to 2022, its use for gynecologic cancers nearly quintupled, jumping from 7% to 34%. Similarly, the application of this approach for pancreatic cancer more than tripled (from 12% to 40%), while rarer cancers affecting the abdominal lining and tissue saw a near doubling (23% to 47%).
According to a senior author of the study, Judy C. Boughey, MD, FACS, chair of the ACS Cancer Research Program and chair of the Division of Breast and Melanoma Surgical Oncology at Mayo Clinic, the benefits of neoadjuvant systemic therapy are twofold. “First, it shrinks the tumor, ideally allowing for less invasive surgery; and second, it allows clinicians to better understand the tumor’s response to systemic treatment, which can help clinicians determine the most effective treatment for a patient.” She further explained that a positive response to pre-surgical medication often correlates with overall treatment success, while a lack of response signals the need to explore alternative therapies.
In-Depth Analysis of Prostate, Esophageal, and Melanoma Cancers
Beyond the broad trends, the report provides detailed insights into three specific cancers: prostate, esophageal, and melanoma.
Prostate Cancer: The data indicates a growing preference for non-surgical treatment options, particularly for Stage 1 prostate cancer. In 2022, approximately 60% of patients with prostate cancer were managed without surgery, up from 54% in 2018. For those who did undergo surgery, prostatectomy – the removal of the prostate gland – remained the most common procedure, performed in 85% of surgical cases. The report also identified key risk factors for mortality, including a prostate-specific antigen (PSA) level exceeding 20 at diagnosis, as well as higher cancer stage and grade.
Esophageal Cancer: The use of immunotherapy in treating esophageal cancer has risen sharply, increasing from 8% to 30% between 2018 and 2022. However, the report highlights a critical challenge: esophageal cancer is frequently diagnosed at an advanced stage, with roughly half of patients presenting with Stage 4 disease. Researchers are urgently calling for the development of effective, widely accessible screening methods to detect the cancer earlier. “If patients with esophageal cancer are diagnosed at less advanced stages, we theorize that more patients could be treated with surgery or other less invasive treatment options,” said Elizabeth B. Habermann, PhD, MPH, chair of the ACS Cancer Data Modeling Pillar and first author of the JACS study.
Melanoma: The report found that melanoma, a potentially deadly skin cancer, most commonly affects the torso (30%) and upper limbs/shoulders (25%). Patients with melanomas on the scalp and neck exhibited the lowest overall survival rates. The presence of ulceration – a breakdown of the skin’s surface – was also linked to poorer outcomes. .
The authors indicated that future reports will delve into additional cancer types, providing researchers and the public with unique data points currently lacking in other cancer databases. This ongoing effort underscores a commitment to improving cancer care through data-driven insights and a deeper understanding of the disease.
