Refusal of colorectal cancer surgery in the United States: Predictors and associated cancer-specific mortality in a Surveillance, Epidemiology, and End Results (SEER) cohort

Delisle, Megan; Singh, Subhash C.; Howard, Jeffrey D.; Panda, Nikhil; Weppler, Alison M.; Wang, Ying

doi:10.1016/j.sopen.2020.07.001

Cited by 12 publications

(7 citation statements)

References 29 publications

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“…1,2 OS disparities between Black and White patients remained after controlling for patient characteristics. Consistent with previous findings in patients with colorectal, breast, or ovarian cancers,[7][8][9][10][11][12] patients with BC who forwent treatment recommendations experienced worse survival than those who received therapies. Furthermore, we found racial and ethnic disparities in OS stratified by treatment decision.…”

supporting

confidence: 89%

“…[4][5][6] Studies have documented elevated risks of all-cause and disease-specific mortality in patients with cancer who forgo treatment recommended by their clinicians. [7][8][9][10][11] Previous research in colorectal, 8,9,11 ovarian, 12 lung, [13][14][15] or mixed cancer cohorts 16,17 has found that older age, racial and ethnic minority background (eg, Hispanic, non-Hispanic Asian or Pacific Islander, or non-Hispanic Black), low socioeconomic status, and late-stage presentations are associated with declination of therapies. For BC, several analyses have reported similar sociodemographic and clinical factors associated with treatment declination in this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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ImportanceDeclining treatment negatively affects health outcomes among patients with cancer. Limited research has investigated national trends of and factors associated with treatment declination or its association with overall survival (OS) among patients with breast cancer.ObjectivesTo examine trends and racial and ethnic disparities in treatment declination and racial and ethnic OS differences stratified by treatment decision in US patients with breast cancer.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data for patients with breast cancer from the 2004 to 2020 National Cancer Database. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery. The chemotherapy cohort included patients with stage I to IV disease. The HT cohort included patients with stage I to IV hormone receptor–positive disease. The radiotherapy and surgery cohorts included patients with stage I to III disease. Data were analyzed from March to November 2023.ExposureRace and ethnicity and other sociodemographic and clinicopathologic characteristics.Main Outcomes and MeasuresTreatment decision, categorized as received or declined, was modeled using logistic regression. OS was modeled using Cox regression. Models were controlled for year of initial diagnosis, age, sex, health insurance, median household income, facility type, Charlson-Deyo comorbidity score, histology, American Joint Committee on Cancer stage, molecular subtype, and tumor grade.ResultsThe study included 2 837 446 patients (mean [SD] age, 61.6 [13.4] years; 99.1% female), with 1.7% American Indian, Alaska Native, or other patients; 3.5% Asian or Pacific Islander patients; 11.2% Black patients; 5.6% Hispanic patients; and 78.0% White patients. Of 1 296 488 patients who were offered chemotherapy, 124 721 (9.6%) declined; 99 276 of 1 635 916 patients (6.1%) declined radiotherapy; 94 363 of 1 893 339 patients (5.0%) declined HT; and 15 846 of 2 590 963 patients (0.6%) declined surgery. Compared with White patients, American Indian, Alaska Native, or other patients (adjusted odds ratio [AOR], 1.47; 95% CI, 1.26-1.72), Asian or Pacific Islander patients (AOR, 1.29; 95% CI, 1.15-1.44), and Black patients (AOR, 2.01; 95% CI, 1.89-2.14) were more likely to decline surgery; American Indian, Alaska Native, or other patients (AOR, 1.13; 95% CI, 1.05-1.21) and Asian or Pacific Islander patients (AOR, 1.21; 95% CI, 1.16-1.27) were more likely to decline chemotherapy; and Black patients were more likely to decline radiotherapy (AOR, 1.05; 95% CI, 1.02-1.08). Asian or Pacific Islander patients (AOR, 0.81; 95% CI, 0.77-0.85), Black patients (AOR, 0.86; 95% CI, 0.83-0.89), and Hispanic patients (AOR, 0.66; 95% CI, 0.63-0.69) were less likely to decline HT. Furthermore, Black patients who declined chemotherapy had a higher mortality risk than White patients (adjusted hazard ratio [AHR], 1.07; 95% CI, 1.02-1.13), while there were no OS differences between Black and White patients who declined HT (AHR, 1.05; 95% CI, 0.97-1.13) or radiotherapy (AHR, 0.98; 95% CI, 0.92-1.04).Conclusions and RelevanceThis cross-sectional study highlights racial and ethnic disparities in treatment declination and OS, suggesting the need for equity-focused interventions, such as patient education on treatment benefits and improved patient-clinician communication and shared decision-making, to reduce disparities and improve patient survival.

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supporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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“…Much attention has been paid to surgery refusal in colorectal cancer patients ( 1 , 9 – 11 , 20 ). Surgery refusal rate for non-metastatic colorectal cancer is increasing over time, which increases colorectal cancer-specific mortality (adjusted HR: 5.10, 95% CI: 4.62-5.62) ( 20 ). Our study indicated that there was a significant black-white disparity in surgery refusal in non-metastatic colorectal cancer, which was largely mediated by patient's socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

“…Those results suggested that hospital level is a key factor influencing patient's trust and decision in taking surgery. Much attention has been paid to surgery refusal in colorectal cancer patients (1,(9)(10)(11)20). Surgery refusal rate for non-metastatic colorectal cancer is increasing over time, which increases colorectal cancerspecific mortality (adjusted HR: 5.10, 95% CI: 4.62-5.62) (20).…”

Section: Discussionmentioning

confidence: 99%

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

Yan

et al. 2022

Front. Public Health

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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.

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“…The clinical data used in this study were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database (AYA site recode/WHO 2008 8.3 Carcinoma of trachea, bronchus, and lung) [ 27 , 28 ]. AYA is a site/histology recode used to analyze data on adolescent and young adults.…”

Section: Methodsmentioning

confidence: 99%

A Machine Learning-Based Investigation of Gender-Specific Prognosis of Lung Cancers

et al. 2021

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Background and Objective: Primary lung cancer is a lethal and rapidly-developing cancer type and is one of the most leading causes of cancer deaths. Materials and Methods: Statistical methods such as Cox regression are usually used to detect the prognosis factors of a disease. This study investigated survival prediction using machine learning algorithms. The clinical data of 28,458 patients with primary lung cancers were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Results: This study indicated that the survival rate of women with primary lung cancer was often higher than that of men (p < 0.001). Seven popular machine learning algorithms were utilized to evaluate one-year, three-year, and five-year survival prediction The two classifiers extreme gradient boosting (XGB) and logistic regression (LR) achieved the best prediction accuracies. The importance variable of the trained XGB models suggested that surgical removal (feature “Surgery”) made the largest contribution to the one-year survival prediction models, while the metastatic status (feature “N” stage) of the regional lymph nodes was the most important contributor to three-year and five-year survival prediction. The female patients’ three-year prognosis model achieved a prediction accuracy of 0.8297 on the independent future samples, while the male model only achieved the accuracy 0.7329. Conclusions: This data suggested that male patients may have more complicated factors in lung cancer than females, and it is necessary to develop gender-specific diagnosis and prognosis models.

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Refusal of colorectal cancer surgery in the United States: Predictors and associated cancer-specific mortality in a Surveillance, Epidemiology, and End Results (SEER) cohort

Cited by 12 publications

References 29 publications

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

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

A Machine Learning-Based Investigation of Gender-Specific Prognosis of Lung Cancers

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