Postoperative Radiation Therapy Refusal in Major Salivary Gland Cancers

Abstract

ObjectiveMajor salivary gland cancers (MSGCs) are often treated with primary surgery followed by adjuvant therapy for high‐risk pathology. Patients with these cancers may opt out of recommended postoperative radiation therapy (PORT) for many reasons and consequently may suffer worse outcomes.Study DesignRetrospective cohort study.SettingNational Cancer Database.MethodsPatients diagnosed with MSGC from 2004 to 2016 were identified, and overall survival and risk factors for refusal of recommended PORT were analyzed based on demographic, socioeconomic, and clinical factors. Multivariable logistic regression and a Cox model were used to conduct the analysis.Results211 out of 4704 qualifying patients (4.5%) refused recommended PORT. Multivariable analysis demonstrated increased PORT refusal for age >74 years (odds ratio OR 4.34, confidence interval [CI] [2.43‐7.85]), Asian race (OR 2.25, CI [1.10‐4.23]), and certain facility types (comprehensive cancer center, OR 2.39, CI [1.08‐6.34]; academic research program, OR 3.29, CI [1.49‐8.74]; and integrated network cancer program, OR 2.75, CI [1.14‐7.7]). N2 stage was associated with decreased PORT refusal (OR 0.67, CI [0.45‐0.98]). The 5‐year overall survival for patients who received and refused PORT were significantly different at 65.8% and 53.8%, respectively (p < .001). When controlling for several factors, PORT refusal was independently associated with significantly lower overall survival (HR 1.54, CI [1.21‐1.98]).ConclusionPatient refusal of recommended PORT in MSGC is rare, associated with various disease and socioeconomic factors, and may decrease overall survival. Our findings can assist clinicians in counseling patients and identifying those who may be more likely to opt out of recommended PORT.

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

“…These factors are predictive of patients refusing recommended adjuvant therapy for MSGC and other head and neck cancers. 40,53 Age-related refusal and a desire to balance quality of life and disease prognosis with the systemic morbidity of adjuvant therapy may also account for this finding. 40 Although treatment-induced toxicities such as xerostomia, dysgeusia, dental caries, and osteoradionecrosis occur more frequently in the elderly and may deter physicians from offering adjuvant therapy, many older patients with advanced MSGC are successfully treated with aRT.…”

“…Patients at risk of missed aRT were older and had more comorbidities. These factors are predictive of patients refusing recommended adjuvant therapy for MSGC and other head and neck cancers 40,53 . Age‐related refusal and a desire to balance quality of life and disease prognosis with the systemic morbidity of adjuvant therapy may also account for this finding 40 .…”