Characterizing “no treatment” decisions in patients with advanced-stage cancers.

Abstract

76 Background: Cancer (CA) is one of the leading causes of death worldwide. In 2020 CA was the second leading cause of mortality in the US. Novel treatments for various malignancies are discovered each passing year. Despite these advancements, some patients refuse to receive treatment. Our study focused on characterizing the group of patients with advanced malignancies who refused therapy. Methods: We performed a retrospective chart review of patients diagnosed with advanced malignancies, aged 18-75 years, between 01/01/ 2010 and 12/31/2015, who refused any therapy. We used Geisinger Health System’s data. Results: Our search provided 644 patients who met our inclusion criteria. The mean age of patients was 63.2 years (standard deviation (σ) 8.3). Female patients made up 40.4% (260/644), while 59.6% (384/644) were male. Most patients were Caucasian (96.9%, 624/644), 1.9% (12/644) were Black; 0.6% (4/644) were Asian, and 0.6% (4/644) were of unknown racial background. Marital status was evenly distributed with 50.0% (322/644) being married and 50.0% (322/644) being non-married. Most of the study population (52.3%, 337/644) had government-funded insurance at the time of CA diagnosis; 46.6% (300/644) had private insurance, and 1.1% (7/644) had no insurance. Stage 3 disease, according to American Joint Committee on Cancer staging was noted in 21.1% (136/644), while 78.9% (508/644) had stage 4 disease. The mean BMI was 28.2 (σ 8.3). Most patients were either overweight or obese (60.6%, 350/577; 67 patients did not have data on BMI available). A history of cigarette smoking was present in 73.0% (438/600). Adenocarcinomas (323/639, 50.5%) were the most prominent histological subtype. The most common site of malignancy was the respiratory system (220/644, 34.2%). Only 9.6% (62/644) of patients had a history of previous CA, while a family history of CA was present in 29.5% (190/644). Most patients (62.1%, 400/644) had a Charleston Comorbidity Index (CCI) > 5; the mean CCI was 6.4 (σ 3.7). In 17.1% (110/644) a palliative medicine referral was made. Substance use disorders were present in 23.8% (153/644); 14.4% (93/644) had a history of depression, and anxiety 10.1% (65/644). Conclusions: Male patients made up a larger proportion of the group of advanced-stage patients who declined therapy. The racial distribution in this group of patients appeared to reflect the local population. Most patients who refused therapy had stage 4 disease, and they appeared to have severe underlying comorbidities, with an average CCI >5. Despite treatment refusal, a surprisingly low percentage of patients were referred to palliative medicine.[Table: see text][Table: see text]