Disparities in surgery for early-stage cancer: the impact of refusal.
Aged
Aged, 80 and over
Female
Healthcare Disparities
/ statistics & numerical data
Humans
Logistic Models
Male
Marital Status
Medically Uninsured
/ statistics & numerical data
Middle Aged
Neoplasms
/ pathology
Treatment Refusal
/ statistics & numerical data
White People
/ statistics & numerical data
Cancer surgery
Early-stage
Refusal
Surgery
Survival
Journal
Cancer causes & control : CCC
ISSN: 1573-7225
Titre abrégé: Cancer Causes Control
Pays: Netherlands
ID NLM: 9100846
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
07
06
2019
accepted:
03
10
2019
pubmed:
21
10
2019
medline:
12
2
2020
entrez:
21
10
2019
Statut:
ppublish
Résumé
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. 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. Increasing age (p < 0.0001 for all four cancer types), non-Hispanic Black race/ethnicity (OR More vulnerable patients are at higher risk of refusing recommended surgery, and this decision negatively impacts their survival.
Sections du résumé
BACKGROUND
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
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
RESULTS
Increasing age (p < 0.0001 for all four cancer types), non-Hispanic Black race/ethnicity (OR
CONCLUSIONS
CONCLUSIONS
More vulnerable patients are at higher risk of refusing recommended surgery, and this decision negatively impacts their survival.
Identifiants
pubmed: 31630307
doi: 10.1007/s10552-019-01240-9
pii: 10.1007/s10552-019-01240-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM