Prevalence and characteristics associated with default of treatment and follow-up in patients with cancer

Abstract

Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds (P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival.

Adherence rate and the factors contribute toward the surgical adherence of breast cancer in Malaysia

“…To our knowledge, this is the first study that specifically defined and address surgical adherence. The study has shown a better adherence rate in comparison with the compliance rate in the same center, which was 66.0% . This implies that once patients agreed with surgery, they followed the recommendations.…”

“…The study has shown a better adherence rate in comparison with the compliance rate in the same center, which was 66.0%. 6 This implies that once patients agreed with surgery, they followed the recommendations. Delay in the presentation was associated with nonadherence to surgery.…”

Colorectal cancer in Taiwan: A case‐control retrospective analysis of the impact of a case management programme on refusal and discontinuation of treatment

“…Chen et al (2015) found that the delay or refusal of treatment in breast cancer patients was associated with older age, catastrophic illness belief and the severity of comorbidity. Chan, Wan Ahmad, Md Yusof, Ho, and Krupat (2015) noted that of 467 cancer patients, 34.0% (N = 159) reported refusal, delay, or discontinuation of treatment or clinic visits and the major associated factor was psychological distress. Gorphe et al (2016) found that advanced laryngeal cancer patients who refused laryngectomy following an insufficient response to induction chemotherapy did not experience decreased functional and oncological outcomes.…”

“…() found that the delay or refusal of treatment in breast cancer patients was associated with older age, catastrophic illness belief and the severity of comorbidity. Chan, Wan Ahmad, Md Yusof, Ho, and Krupat () noted that of 467 cancer patients, 34.0% ( N = 159) reported refusal, delay, or discontinuation of treatment or clinic visits and the major associated factor was psychological distress. Gorphe et al.…”

Course and predictors of post‐traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4‐year follow‐up study

“…In our prior work with this cohort, the rate of treatment nonadherence or default (34%) was significant, although it was not linked to rates of psychological distress. 35 Breast cancer appeared to be a protective factor for PTSD at 6-months, but not at 4-years, follow-up. Because breast cancer is a very common malignancy, it is possible that greater societal understanding and the wider availability of support programs tailored for breast cancer (compared with the fewer support programs for patients with other cancer types) initially serve as protective factors against PTSD, but that this protective effect attenuates with distance from the original diagnosis.…”