Beth Sandy, MSN, CRNP
In 2021, the American Cancer Society (ACS) reported a substantial decrease in cancer-related mortality in the United States. This data represents incidence and mortality rates through the 2017-2018 years. The ACS report for 2021 reported a record 2.4% decline in cancer mortality from 2017-2018, following a record 2.2% decline from the previous year. Given the time lag for reporting and analyzing data, this report does not take into account the impact of COVID, which we may see reflected in future reports.
When you break down the numbers, it appears the largest gain in decreased mortality was in lung cancer. During this timeframe, there was no improvement in survival for small cell lung cancer (SCLC), however, there was a significant decline in incidence largely due to a decrease in cigarette smoking, resulting in less mortality overall in lung cancer. Non-small cell lung cancer (NSCLC) mortality significantly declined, with a decrease of 6.3% annually from 2013-2016. This trend was seen across all races and ethnicities and was similar in women as well.
Given that this significant decline started around 2013 and this data is reflected up to 2018, the majority of the decrease in cancer mortality related to NSCLC is likely attributed to the approvals of 2nd and 3rd generation targeted therapies over this timeframe. Drugs such as erlotinib and gefitinib were approved in the mid-2000’s, but since then, the 3rd generation epidermal growth factor receptor (EGFR) inhibitor, osimertinib has been approved and is associated with a survival advantage over the other 2 EGFR inhibitors. Also, other 2nd and 3rd generation targeted therapies for mutations and variants for NSCLC to target ALK and ROS1 were approved during this timeframe, significantly improving survival in patients harboring these mutations or variants.
While immunotherapy has undoubtedly improved survivals in NSCLC, these checkpoint inhibitors were only approved in 2015, so these numbers are not largely reflected yet in this dataset. Also, of note, advances were not seen in cervical cancer as well as across racial and ethnic minorities, revealing that there is work to do in categories such as screening and vaccines, as well as attention to the racial and ethnic disparities in cancer diagnoses and outcomes.
As a thoracic oncology nurse practitioner, this data is so exciting. To finally see our patients living longer with lung cancer is a relief and a reality that advances are being made in this population where often patients do not live long enough to advocate for themselves and their fellow survivors. We can only imagine and hope that these numbers continue to improve in the upcoming years once the data reflects the improvements in cancer survival reflected in the literature for immune checkpoint inhibitors, especially in patients with lung cancer.
Howlander N, Forjaz G, Mooradian M, et al. The Effect of Advances in Lung-Cancer Treatment on Population Mortality. N Engl J Med 2020;383:640-9.
Siegel RL, Miller, KD, Fuchs HE & Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021;71:7-33.
Soria J-C, Ohe Y, Vansteenkiste J, et al. Osimertinib in Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer. N Engl J Med. 2018;378(2):113-125.
Beth Sandy, MSN, CRNP
Thoracic Oncology Nurse Practitioner – Abramson Cancer Center, University of Pennsylvania
