Abstract
Cancer treatment causes adverse effects that lead to refusal or discontinuation of treatment. The purposes of this study were to identify 1) the factors associated with and 2) the reasons for refusing and discontinuing treatment in patients with bladder cancer (BC). We conducted a retrospective cohort study in patients diagnosed with BC in Taiwan from 1 January 2014 to 30 June 2019 using a linked cancer registry database. Of the 1247 BC patients in the study cohort, 2.1% reported refusing treatment. Patients with less education and those diagnosed at cancer stage II–IV were more likely to refuse treatment. The major reason for refusing treatment was “patient or the family considered patient’s poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment”. A total of 4.3% of BC patients reported discontinuing treatment. Patients not living in the northern region of Taiwan and those diagnosed at cancer stage II–IV were more likely to terminate treatment before completion. The major reason given for discontinuing treatment was inconvenient transportation. Sufficient social resources and supportive care can help BC patients cope with the physical and psychological burden of treatment.
Highlights
Cancer is a leading cause of mortality worldwide, with bladder cancer (BC) the10th most common cancer worldwide and the seventh most common in men, with an estimated 430,000 new cases diagnosed every year [1,2]
Most patients lived in the north (93.3%), which reflects that the data for this study came from a medical center in Northern Taiwan; public transportation availability resulted in medical accessibility
Results of the present study showed that BC patients with fewer years of education and those diagnosed at cancer stage II–IV were more likely to refuse treatment
Summary
Cancer is a leading cause of mortality worldwide, with bladder cancer (BC) the. 10th most common cancer worldwide and the seventh most common in men, with an estimated 430,000 new cases diagnosed every year [1,2]. In Taiwan, BC represents the ninth most frequent cancer in males, with approximately 1700 incident cases per year [3]. Occupational exposure, tobacco smoking, and age all increase the risk of BC, a cancer with a high recurrence rate and progression that requires repeated therapies [4]. Surgery alone or combined with chemotherapy (CT) or concurrent chemoradiation therapy (CCRT) are the major treatments for BC [4]. Adverse effects associated with these treatments include temporal or permanent changes in bladder function (such as bladder 4.0/).
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