Future trends in incidence and long-term survival of metastatic cancer in the United States

BACKGROUND: Previous studies have demonstrated epidemiological trends in individual metastatic cancer subtypes; however, research forecasting long-term incidence trends and projected survivorship of metastatic cancers is lacking. We assess the burden of metastatic cancer to 2040 by (1) characterizing past, current, and forecasted incidence trends, and (2) estimating odds of long-term (5-year) survivorship. METHODS: This retrospective, serial cross-sectional, population-based study used registry data from the Surveillance, Epidemiology, and End Results (SEER 9) database. Average annual percentage change (AAPC) was calculated to describe cancer incidence trends from 1988 to 2018. Autoregressive integrating moving average (ARIMA) models were used to forecast the distribution of primary metastatic cancer and metastatic cancer to specific sites from 2019 to 2040 and JoinPoint models were fitted to estimate mean projected annual percentage change (APC). RESULTS: The average annual percent change (AAPC) in incidence of metastatic cancer decreased by 0.80 per 100,000 individuals (1988–2018) and we forecast an APC decrease by 0.70 per 100,000 individuals (2018–2040). Analyses predict a decrease in metastases to liver (APC = −3.40, 95% CI [−3.50, −3.30]), lung (APC (2019–2030) = −1.90, 95% CI [−2.90, −1.00]); (2030–2040) = −3.70, 95% CI [−4.60, −2.80]), bone (APC = −4.00, 95% CI [−4.30, −3.70]), and brain (APC = −2.30, 95% CI [−2.60, −2.00]). By 2040, patients with metastatic cancer are predicted to have 46.7% greater odds of long-term survivorship, driven by increasing plurality of patients with more indolent forms of metastatic disease. CONCLUSIONS: By 2040, the distribution of metastatic cancer patients is predicted to shift in predominance from invariably fatal to indolent cancers subtypes. Continued research on metastatic cancers is important to guide health policy and clinical intervention efforts, and direct allocations of healthcare resources.