Refusal of Cancer-Directed Surgery by Breast Cancer Patients: Risk Factors and Survival Outcomes

Refusal of Cancer‐Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

“…Older patients were significantly more likely to dismiss recommended surgical interventions, with patients over 75 years old more than four times as likely to refuse surgery compared to those younger than 50. These results are in concordance with previous findings that elderly patients tend to be operated on less than younger patients, and are more likely to refuse recommended surgery in studies of prostate, breast, and hepatocellular cancer . Uncertainty over the number of remaining years with a high quality of life may preferentially dissuade older patients from undergoing aggressive surgery.…”

“…Similar psychosocial effects have been observed in patients undergoing mastectomy for breast cancer . In this population, studies have found that the implications of mastectomy and breast reconstruction have led a small percentage of women to refuse recommended surgery, and a number of risk factors for refusal have been identified …”

Declining recommended surgery in primary cutaneous melanoma: an analysis of risk factors and survival

“…Dermoscopy in this latter case showed the same images as in our patient. 6 In our observation, the spicules were cleared both in clinical and dermoscopic examination after a 6-month treatment with chemotherapy. Our case adds a dermoscopic feature to the trichoscopic spectrum of FMF previously reported by Slawinska et al 1…”

“…Studies with similar results have also discussed the possibility of a lack of support system to help with patient decisionmaking and to facilitate postsurgical care. 6,7 Malignancies of the face and lower limbs were approximately two times as likely to not undergo recommended surgery compared with those of the trunk-the most common location for melanoma primaries. 8 This result may be due to the aesthetic nature of possibly disfiguring surgery, as the face and legs are more exposed areas.…”

Addressing fragmentation of care requires strengthening of health systems and cross‐institutional collaboration

“…For example, patients who received care at multiple high‐volume hospitals were more likely to have higher incomes, higher education levels, and greater resources to potentially seek care at >1 hospital. Prior studies have shown that patients who historically have been marginalized, lack support, or have inadequate health insurance were more likely to refuse surgery for a cancer diagnosis, and may not have sought care at multiple high‐volume institutions . In fact, Hester et al demonstrated that in their study, uninsured patients comprised a significantly higher percentage of the patients who received nonfragmented care compared with patients who received fragmented care .…”