P1.17-28 Refusal of Surgery for Early Stage Lung Cancer: Risk Factors and Survival

Abstract

The standard of care for treatment of early stage non-small cell lung cancer (NSCLC) is surgical resection. However, suitable patients refuse surgery for various reasons. We characterize the clinical and sociodemographic predictors of those who refuse recommended surgery for early stage NSCLC cancers and explore the influence of surgical compliance on survival. Primary Stage I and II NSCLC cases diagnosed between 2007 and 2014 were selected from the Surveillance, Epidemiology and End Results (SEER) database (n = 36,926). All cases were recommended surgery for treatment. Predictors of surgery refusal were examined using multivariate logistic regression. The likelihood of mortality after refusing surgery and any chemotherapy/radiation and refusing surgery but receiving alternative forms of treatment was performed using a cox proportional hazards model. Propensity-matched survival analysis was then performed between those who received surgery and those who refused surgery. SAS v9.4 was used for statistical analyses. The majority of the sample was non-Hispanic White (79%), female (52%), married (57%) and Stage I (83%). Most were between 50-64 years old (31%) or 65-79 years old (55%) and had tumor sizes of 11-20 mm (32%), 21-40 mm (42%), or > 40 mm (20%); 909 cases (2.5%) refused surgical intervention. Of these, 634 (69.7%) cases underwent radiation therapy and 87 (9.6%) received chemotherapeutic treatment. At multivariable analysis, non-Hispanic blacks (ORadj 2.14, 95% CI: 1.76-2.61), increasing age (65-79 years old: ORadj 4.29, 95% CI: 2.02-9.11), increasing tumor size (21-40 mm: ORadj 2.79, 95% CI: 1.73-4.50), and single marital status (ORadj 2.14, 95% CI: 1.85-2.48) were associated with increased odds of surgical refusal. Stage II lung cancer was inversely associated (ORadj 0.75, 95% CI: 0.62-0.92) with surgical refusal. Refusing surgery and having no chemotherapy/radiation (HRadj 4.16, 95% CI: 3.48-4.96) as well as refusing surgery but undergoing alternative forms of treatment (HRadj 2.90, 95% CI: 2.55-3.29) were associated with increased mortality compared to those who received recommended surgery. After propensity matching (n = 1790), refusing surgery was associated with increased likelihood of mortality (HRadj 2.77, 95% CI: 2.22-3.46). Identifiable risk factors exist for refusing recommended surgery for Stage I/II NSCLC, and refusal is associated with an increased likelihood of mortality. Recognizing that certain subgroups are more likely to refuse surgery is vital when providing treatment choices and reducing disparities in survival for early stage lung cancer.