Cancer treatment refusal decisions in advanced cancer: a retrospective case-control study

Ogheneyoma Akpoviroro; Nathan Kyle Sauers; Oghenetejiro Princess Akpoviroro; Queeneth Uwandu; Myriam Castagne; Elga Rodrigues; Patrick May; Meredith Lewis; Brian Bolden; Wasique Mirza

doi:10.1136/spcare-2022-003976

Cancer treatment refusal decisions in advanced cancer: a retrospective case-control study

BMJ Support Palliat Care. 2023 Jun 9:spcare-2022-003976. doi: 10.1136/spcare-2022-003976. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA oakpoviroro@geisinger.edu.
² Department of Engineering, Pennsylvania State University, State College, Pennsylvania, USA.
³ Department of Medicine, Mater Dei Hospital, Msida, Malta.
⁴ Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.
⁵ General Clinical Research Center, Clinical and Translational Science Institute, Boston University, Boston, Massachusetts, USA.
⁶ Department of Surgery, Boston University, Boston, Massachusetts, USA.
⁷ Department of Biostatistics, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.
⁸ Phenomic Analytics & Clinical Data Core Department, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.
⁹ Department of Palliative Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.

PMID: 37295924
DOI: 10.1136/spcare-2022-003976

Abstract

Objective: Cancer remains one of the leading causes of death worldwide. Despite advancements in anticancer therapy, some patients decide against treatment. Our study focused on characterising therapy refusal in advanced-stage malignancies and further determining if certain variables significantly correlated with refusal, compared with acceptance.

Methods: Our inclusion criteria were patients aged 18-75 years, stage IV cancers between 1 January 2010 and 31 December 2015 and treatment refusal (cohort 1 (C1)). A randomly selected group of patients with stage IV cancers who accepted treatment within the same timeframe was used for comparison (cohort 2 (C2)).

Results: There were 508 patients in C1 and 100 patients in C2. Female sex was associated with treatment acceptance (51/100, 51.0%) than refusal (201/508, 39.6%); p=0.03. There were no associations between treatment decisions and race, marital status, BMI, tobacco use, previous cancer history, or family cancer history. Government-funded insurance was associated with treatment refusal (337/508, 66.3%) than acceptance (35/100, 35.0%); p<0.001. Age was associated with refusal (p<0.001). Average age of C1 was 63.1 years (SD:8.1) and C2 was 59.2 years (SD:9.9). Only 19.1% (97/508) in C1 were referred to palliative medicine, with 18% (18/100) in C2; p=0.8. There was a trend for patients who accepted therapy to have more comorbidities per the Charlson Comorbidity Index(p=0.08). The treatment of psychiatric disorders after cancer diagnosis was inversely associated with treatment refusal (p<0.001).

Conclusions: The treatment of psychiatric disorders after cancer diagnosis was associated with cancer treatment acceptance. Male sex, older age and government-funded health insurance were associated with treatment refusal in patients with advanced cancer. Those who refused treatment were not increasingly referred to palliative medicine.

Keywords: Cancer; Other cancer; Psychological care.