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Erschienen in: Annals of Surgical Oncology 2/2021

07.07.2020 | Health Services Research and Global Oncology

Refusal of Cancer-Directed Surgery in Patients with Colon Cancer: Risk Factors of Refusal and Survival Data

verfasst von: Gabriel S. Makar, MD, Michael Makar, MD, Chioma Obinero, MD, William Davis, MD, John P. Gaughan, MS, PhD, MBA, Michael Kwiatt, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2021

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Abstract

Introduction

Colon cancer is the third leading cause of cancer-related deaths. Although there have been numerous advancements in treatment options, electing to undergo surgery is a difficult decision, and some patients may be hesitant to undergo surgery. We sought to understand the risk factors associated with refusal of surgery and predictors of mortality in patients with colon cancer.

Methods

We retrospectively reviewed the Surveillance, Epidemiology, and End Results database for patients diagnosed with colon cancer from 1995 to 2015. We stratified patients according to whether they underwent surgery or refused recommended surgery. We analyzed numerous demographic, surgical, and oncologic variables and performed univariate analysis to assess predictors for refusal of surgery as well as survival and mortality risk in those refusing surgery.

Results

Our analysis included 288,322 patients with primary colon cancer where 284,591 (98.7%) underwent cancer-direct surgery and 3731 (1.3%) refused recommended surgery. Those refusing cancer directed surgery were more likely to be > 70 years old, non-Hispanic black patients, and have distant staged cancer (all p < 0.001). In those refusing surgery, risks for mortality included older age, female gender, widowhood, higher grade or distant-staged cancer, and a positive CEA.

Conclusions

Disparities in care related to patient race, gender, and insurance status were related to patients who refused surgical interventions. This study helps to identify patients who are more likely to refuse surgery and may assist in navigating conversations with patients who are contemplating treatment options.
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Metadaten
Titel
Refusal of Cancer-Directed Surgery in Patients with Colon Cancer: Risk Factors of Refusal and Survival Data
verfasst von
Gabriel S. Makar, MD
Michael Makar, MD
Chioma Obinero, MD
William Davis, MD
John P. Gaughan, MS, PhD, MBA
Michael Kwiatt, MD
Publikationsdatum
07.07.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 2/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08783-1

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