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Original research
Cancer treatment refusal decisions in advanced cancer: a retrospective case–control study
  1. Ogheneyoma Akpoviroro1,
  2. Nathan Kyle Sauers2,
  3. Oghenetejiro Princess Akpoviroro3,
  4. Queeneth Uwandu1,
  5. Myriam Castagne4,
  6. Elga Rodrigues5,
  7. Patrick May6,
  8. Meredith Lewis7,
  9. Brian Bolden8 and
  10. Wasique Mirza1
  1. 1Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
  2. 2Department of Engineering, Pennsylvania State University, State College, Pennsylvania, USA
  3. 3Department of Medicine, Mater Dei Hospital, Msida, Malta
  4. 4General Clinical Research Center, Clinical and Translational Science Institute, Boston University, Boston, Massachusetts, USA
  5. 5Department of Surgery, Boston University, Boston, Massachusetts, USA
  6. 6Department of Biostatistics, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
  7. 7Phenomic Analytics & Clinical Data Core Department, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
  8. 8Department of Palliative Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
  1. Correspondence to Dr Ogheneyoma Akpoviroro, Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, USA; oakpoviroro{at}geisinger.edu

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.

  • Cancer
  • Other cancer
  • Psychological care

Data availability statement

All data relevant to the study are included in the article or uploaded as an online supplemental information.

https://doi.org/10.1136/spcare-2022-003976

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as an online supplemental information.

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    Footnotes

    • Twitter @ogakpoviroro

    • Contributors OA was responsible for conception of the study and study design, literature review, data analysis and manuscript writing. NKS and PM were responsible for data analysis and manuscript writing. OPA, QU, MC, ER, BB, ML and WM were responsible for manuscript writing. OA serves as guarantor for this manuscript.

    • Funding This research received no specific external grants from any funding agency in the public, commercial, or not-for-profit sectors. This study was funded internally by Geisinger Health System. No specific funds were provided to any of the authors listed in the byline for the execution of this study and the resulting manuscripts.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.