Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results

Xianglin Hu,Hui Ye,Yangbai Sun,Wangjun Yan

doi:10.3389/fpubh.2021.785602

Abstract

ObjectivesMost non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial/ethnic disparities in surgery refusal.MethodsBased on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial/ethnic categories were included: White, black, Hispanic, and Asian/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI).ResultsAmong 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); those racial/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung/bronchus, liver, and stomach cancers.ConclusionsPatient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.

Highlights

Patients with non-metastatic cancers have an opportunity to receive surgery and subsequently harvest a preferable survival, there is always no cancer-directed surgery available to them
The incidence of recommended but unperformed surgery was 9.4% (29,932/318,318); it was more prevalent in breast (33.6%), colorectal (25.0%), uterus (19.2%), and kidney/renal pelvis (18.4%) cancers
The incidence of patient’s refusal of recommended surgery was 3.5% (11,221/318,318); it was more prevalent in breast (12.6%), colorectal (12.2%), uterus (10.3%), and kidney/renal pelvis (9.1%) cancers (Figure 1)

Summary

Introduction

Patients with non-metastatic cancers have an opportunity to receive surgery and subsequently harvest a preferable survival, there is always no cancer-directed surgery available to them It remains unknown which and how many reasons for non-cancer-directed surgery exist in various nonmetastatic cancers. It has been found that black patients are more likely to refuse recommended surgery than white patients in several cancers [1,2,3] It is unclear whether black-white disparities in refusal are largely mediated by patient’s socioeconomic status, such as insurance type and marital status. This study seeks to explore whether that racial/ethnic disparity in refusal could be narrowed down by controlling the factors such as insurance type and marital status

Objectives

Methods

Results