Joseph Rapp1, Stephanie Tuminello1, Naomi Alpert1, Raja M Flores2, Emanuela Taioli3,4,5,6. 1. Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Emanuela.taioli@mountsinai.org. 4. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Emanuela.taioli@mountsinai.org. 5. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Emanuela.taioli@mountsinai.org. 6. Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA. Emanuela.taioli@mountsinai.org.
Abstract
BACKGROUND: For early-stage cancer surgery is often curative, yet refusal of recommended surgical interventions may be contributing to disparities in patient treatment. This study aims to assess predictors of early-stage cancers surgery refusal, and the impact on survival. METHODS: Patients recommended surgery with primary stage I and II lung, prostate, breast, and colon cancers, diagnosed between 2007-2014, were identified in the Surveillance, Epidemiology and End Results database (n = 498,927). Surgery refusal was reported for 5,757 (1.2%) patients. Associations between sociodemographic variables and surgery refusal by cancer type were assessed in adjusted multivariable logistic regression models. The impact of refusal on survival was investigated using adjusted Cox-Proportional Hazard regression in a propensity score-matched cohort. RESULTS: Increasing age (p < 0.0001 for all four cancer types), non-Hispanic Black race/ethnicity (ORadjBREAST 2.00, 95% CI 1.68-2.39; ORadjCOLON 3.04, 95% CI 2.17-4.26; ORadjLUNG 2.19, 95% CI 1.77-2.71; ORadjPROSTATE 2.02, 95% CI 1.86-2.20; vs non-Hispanic White), insurance status (uninsured: ORadjBREAST 2.75, 95% CI 1.89-3.99; ORadjPROSTATE 2.10, 95% CI 1.72-2.56; vs insured), marital status (ORadjBREAST 2.16, 95% CI 1.85-2.51; ORadjCOLON 1.56, 95% CI 1.16-2.10; ORadjLUNG 2.11, 95% CI 1.80-2.47; ORadjPROSTATE 1.94, 95% CI 1.81-2.09), and stage (ORadjBREAST 1.94, 95% CI 1.70-2.22; ORadjCOLON 0.13, 95% CI 0.09-0.18; ORadjLUNG 0.71, 95% CI 0.52-0.96) were all associated with refusal; patients refusing surgery were at increased risk of death compared to patients who underwent surgery. CONCLUSIONS: More vulnerable patients are at higher risk of refusing recommended surgery, and this decision negatively impacts their survival.
BACKGROUND: For early-stage cancer surgery is often curative, yet refusal of recommended surgical interventions may be contributing to disparities in patient treatment. This study aims to assess predictors of early-stage cancers surgery refusal, and the impact on survival. METHODS:Patients recommended surgery with primary stage I and II lung, prostate, breast, and colon cancers, diagnosed between 2007-2014, were identified in the Surveillance, Epidemiology and End Results database (n = 498,927). Surgery refusal was reported for 5,757 (1.2%) patients. Associations between sociodemographic variables and surgery refusal by cancer type were assessed in adjusted multivariable logistic regression models. The impact of refusal on survival was investigated using adjusted Cox-Proportional Hazard regression in a propensity score-matched cohort. RESULTS: Increasing age (p < 0.0001 for all four cancer types), non-Hispanic Black race/ethnicity (ORadjBREAST 2.00, 95% CI 1.68-2.39; ORadjCOLON 3.04, 95% CI 2.17-4.26; ORadjLUNG 2.19, 95% CI 1.77-2.71; ORadjPROSTATE 2.02, 95% CI 1.86-2.20; vs non-Hispanic White), insurance status (uninsured: ORadjBREAST 2.75, 95% CI 1.89-3.99; ORadjPROSTATE 2.10, 95% CI 1.72-2.56; vs insured), marital status (ORadjBREAST 2.16, 95% CI 1.85-2.51; ORadjCOLON 1.56, 95% CI 1.16-2.10; ORadjLUNG 2.11, 95% CI 1.80-2.47; ORadjPROSTATE 1.94, 95% CI 1.81-2.09), and stage (ORadjBREAST 1.94, 95% CI 1.70-2.22; ORadjCOLON 0.13, 95% CI 0.09-0.18; ORadjLUNG 0.71, 95% CI 0.52-0.96) were all associated with refusal; patients refusing surgery were at increased risk of death compared to patients who underwent surgery. CONCLUSIONS: More vulnerable patients are at higher risk of refusing recommended surgery, and this decision negatively impacts their survival.
Entities:
Keywords:
Cancer surgery; Early-stage; Refusal; Surgery; Survival
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