Characteristics of Breast Cancer Patients Who Refuse Surgery

Abstract

Aim: This study describes the demographic, socioeconomic, and tumor-specific characteristics of patients who refuse breast cancer surgery. Materials and Methods: This is a retrospective study of breast cancer patients from 2004-2015 captured by the National Cancer Data Base. Demographic, socioeconomic, and tumor-specific predictors were compared between patients who refused breast cancer surgery versus those who agreed to surgery, using bivariate and multivariate models. Results: A total of 2,445,870 patients met the inclusion criteria. On multivariate analysis, black and Asian patients had higher odds of refusing surgical treatment compared to whites (OR=2.16, CI=2. p<0.001), (OR=1.58, p<0.001), respectively. Moreover, patients with government insurance (OR=1.97, CI=1.86-2.09, p<0.001) and uninsured patients (OR=3.91, p<0.001) were found to have higher odds of surgical treatment refusal when compared to patients with private insurance. Conclusion: Specific demographic and disease-specific characteristics are related to refusing potentially life-saving breast cancer surgery.In 2019, 1,762,450 new breast cancer cases and 606,880 cancer deaths are projected to occur in the United States (1). Furthermore, breast cancer is the most common cancer in women and second most common cause of cancer death (1). Refusing surgery is a brave decision that has a deleterious effect on breast cancer mortality and is more commonly related to advanced disease, which has a poor prognosis (2). Previous studies focused on patients with pancreatic cancer who refused surgery demonstrated that there were disparities in the refusal of cancer-directed surgery and that several variables, such as insurance, sex, and race, were independently associated to this outcome (3, 4). However, studies on breast cancer have not elucidated groups likely to refuse surgical treatment. Therefore, this study's objective was to describe the demographic, socioeconomic, and tumor-specific characteristics related to surgery refusal in the United States (US) breast cancer population using the National Cancer Database (NCDB).

Breast Cancer and COVID-19: The Effect of Fear on Patients' Decision-making Process

“…Among the 82 patients who underwent surgical evaluation for SBL, no significant statistical differences were found between PRE-COVID-19-SBL and POST-COVID-19-SBL groups regarding personal and anamnestic data like age, diameter of SBL, personal and family history of BC. Table I summarizes the findings showing homogeneity in both groups regarding these potential confounding factors (18)(19)(20)(21). Grouping population according to BI-RADS lexicon showed no statistically significant differences between the two different periods of analysis.…”

“…Even in normal times, fear and anxiety play a major role in the course of patients' disease. About 0.64% of BC patients refuse surgical treatment according to SEER database (19,21). Personal and socioeconomic conditions were linked to surgical treatment refusal, including higher age at diagnosis, female gender, Ethnicity, type of insurance, LABC (stage II and III BC), non-triple-negative breast cancer, residence areas with a low percentage of high school diplomas (21).…”

“…Retrospective data collection from the clinical notes of both groups included age, personal and family history of BC as well as marital status. The impact of these variables on the probability of surgical refusal (SR) have already been analyzed in literature (18)(19)(20)(21). Moreover, during the COVID-19 outbreak, all patients were interviewed via telephone in order to evaluate information regarding infection risk prior to the visit, as required by our facilities.…”

Disparities in Access to Autologous Breast Reconstruction

“…Unfortunately, disparities affecting breast cancer patients are not limited to autologous reconstruction. Our group has shown that the rate of breast reconstruction, refusal of surgical treatment, and the survival of male patients with breast cancer has also been shown to be affected by ethnic and demographic characteristics [ 21 , 22 , 23 , 24 ].…”

Immunotherapy is Associated with a Survival Benefit in Patients Receiving Chemotherapy for Metastatic&nbsp;Pancreas Cancer

“…[37][38][39] Previous reports identi ed that Black and Asian patients, those who live alone, were unmarried or did not have children, had government issued insurance, or had issues performing their activities of daily living were more likely to decline all treatment. [40,41] Although our study includes data on a large number of PDAC patients, there are limitations. Importantly, the use of immunotherapy is not common therefore the IT-CT treatment group is small in comparison to those who received CT alone.…”