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

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.

Racial and ethnic disparities in the refusal of surgical treatment in women 40 years and older with breast cancer in the USA between 2010 and 2017

“…Non-Hispanic Blacks were more likely to refuse getting surgery as recommended for breast cancer compared to Non-Hispanic Whites. This is consistent with similar studies that have assessed the predictors of breast cancer-recommended surgery refusal [7,[14][15][16][17][18][19]. This finding can be attributed to low socioeconomic status (SES) and distrust of health care among racial minorities [7,27,29].…”

“…Increasing age was also significantly associated with an increased odds of refusing recommended surgery being performed, which was disproportionate for women aged 80 years and older compared to those aged 40-49 years consistent with other studies on the topic [7,[14][15][16][17][18][19]. Advanced age is associated with an increased risk for comorbidities and decreased survival after cancer treatment [4,31].…”

“…Post-surgery patients may develop declining psychosocial functioning with respect to their quality of life, cancer-related distress, sexual dysfunction, body image dysmorphism, anxiety, and depression, hence affecting surgery refusal rates [7,[11][12][13]. Previous studies have also found age, race, marital status, health insurance, and income level to be associated with surgery refusal, with NH Black patients being less likely to receive breast cancer surgical treatment [7,[14][15][16][17][18][19]. However, those previous studies focused on data prior to 2014.…”

Recent Progress in Second Near-Infrared (NIR-II) Fluorescence Imaging in Cancer

“…Cancer is one of the most fatal diseases and leading causes of human death around the world, and its prevention remains a serious issue [ 1 ]. Due to the inefficient sensitivity, specificity, and resolution of traditional diagnostic modalities, early-stage tumors, especially tiny lesions, cannot be effectively detected [ 2 , 3 , 4 ].…”

Racial and Ethnic Disparities in the Refusal of Surgical Treatment in Women 40 years and older with Breast Cancer in the United States between 2010 and 2017

“…Post-surgery patients may develop declining psychosocial functioning with respect to their quality of life, cancer-related distress, sexual dysfunction, body image dysmorphism, anxiety, and depression, hence affecting surgery refusal rates [7,[11][12][13]. Previous studies have also found age, race, marital status, and income level to be associated with surgery refusal, with NH Black patients being less likely to receive breast cancer surgical treatment [7,[14][15][16][17][18][19]. However, these studies focused on data prior to 2014.…”