Edward Christopher Dee1,2, Melaku A Arega2, David D Yang1, Santino S Butler3, Brandon A Mahal4,5, Nina N Sanford6, Paul L Nguyen1, Vinayak Muralidhar1. 1. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. Harvard Medical School, Boston, MA. 3. Department of Internal Medicine, Kaiser Permanente, Northern California, Oakland Medical Center, Oakland, CA. 4. Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL. 5. Office of Community Outreach and Engagement, Sylvester Comprehensive Cancer Center, Miami, FL. 6. Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX.
Abstract
PURPOSE: We assessed sociodemographic factors associated with and survival implications of refusal of potentially survival-prolonging locoregional treatment (LT, including radiotherapy and surgery) despite provider recommendation among men with localized prostate adenocarcinoma. METHODS: The National Cancer Database (2004-2015) identified men with TxN0M0 prostate cancer who either received or refused LT despite provider recommendation. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of refusing LT, with sociodemographic and clinical covariates. Models were stratified by low-risk and intermediate- or high-risk (IR or HR) disease, with a separate interaction analysis between race and risk group. Multivariable Cox proportional hazard ratios compared overall survival (OS) among men who received versus refused LT. RESULTS: Of 887,839 men (median age 64 years, median follow-up 6.14 years), 2,487 (0.28%) refused LT. Among men with IR or HR disease (n = 651,345), Black and Asian patients were more likely to refuse LT than White patients (0.35% v 0.29% v 0.17%; Black v White AOR, 1.75; 95% CI, 1.52 to 2.01; P < .001; Asian v White AOR, 1.47; 95% CI, 1.05 to 2.06; P = .027, race * risk group interaction P < .001). Later year of diagnosis, community facility type, noninsurance or Medicaid, and older age were also associated with increased odds of LT refusal, overall and when stratifying by risk group. For men with IR or HR disease, LT refusal was associated with worse OS (5-year OS 80.1% v 91.5%, HR, 1.65, P < .001). CONCLUSION: LT refusal has increased over time; racial disparities were greater in higher-risk disease. Refusal despite provider recommendation highlights populations that may benefit from efforts to assess and reduce barriers to care.
PURPOSE: We assessed sociodemographic factors associated with and survival implications of refusal of potentially survival-prolonging locoregional treatment (LT, including radiotherapy and surgery) despite provider recommendation among men with localized prostate adenocarcinoma. METHODS: The National Cancer Database (2004-2015) identified men with TxN0M0 prostate cancer who either received or refused LT despite provider recommendation. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of refusing LT, with sociodemographic and clinical covariates. Models were stratified by low-risk and intermediate- or high-risk (IR or HR) disease, with a separate interaction analysis between race and risk group. Multivariable Cox proportional hazard ratios compared overall survival (OS) among men who received versus refused LT. RESULTS: Of 887,839 men (median age 64 years, median follow-up 6.14 years), 2,487 (0.28%) refused LT. Among men with IR or HR disease (n = 651,345), Black and Asian patients were more likely to refuse LT than White patients (0.35% v 0.29% v 0.17%; Black v White AOR, 1.75; 95% CI, 1.52 to 2.01; P < .001; Asian v White AOR, 1.47; 95% CI, 1.05 to 2.06; P = .027, race * risk group interaction P < .001). Later year of diagnosis, community facility type, noninsurance or Medicaid, and older age were also associated with increased odds of LT refusal, overall and when stratifying by risk group. For men with IR or HR disease, LT refusal was associated with worse OS (5-year OS 80.1% v 91.5%, HR, 1.65, P < .001). CONCLUSION: LT refusal has increased over time; racial disparities were greater in higher-risk disease. Refusal despite provider recommendation highlights populations that may benefit from efforts to assess and reduce barriers to care.
Authors: Nishwant Swami; Yefri A Baez; Idalid Franco; Tiffany Nguyen; Karthik Meiyappan; Minh Ton; Bhav Jain; Crystal Seldon; Kenrick Ng; Narjust Duma; Mohammed Alshalalfa; Kosj Yamoah; Paul L Nguyen; Brandon A Mahal; Edward Christopher Dee Journal: Prostate Cancer Prostatic Dis Date: 2022-03-19 Impact factor: 5.554
Authors: Bhav Jain; Kenrick Ng; Patricia Mae G Santos; Kekoa Taparra; Vinayak Muralidhar; Brandon A Mahal; Neha Vapiwala; Quoc-Dien Trinh; Paul L Nguyen; Edward Christopher Dee Journal: JCO Oncol Pract Date: 2021-10-28
Authors: Bahaa Kazzi; Fumiko Chino; Brigitte Kazzi; Bhav Jain; Sibo Tian; Joseph A Paguio; J Seth Yao; Vinayak Muralidhar; Brandon A Mahal; Paul L Nguyen; Nina N Sanford; Edward Christopher Dee Journal: Support Care Cancer Date: 2022-07-25 Impact factor: 3.359
Authors: Urvish Jain; Bhav Jain; Oluwadamilola M Fayanju; Fumiko Chino; Edward Christopher Dee Journal: Am J Surg Date: 2022-01-22 Impact factor: 3.125