Sociodemographic predictors of surgery refusal in patients with stage I-III colon cancer.
Adenocarcinoma
/ epidemiology
Age Factors
Aged
Aged, 80 and over
Colonic Neoplasms
/ epidemiology
Databases, Factual
Female
Humans
Insurance, Health
/ statistics & numerical data
Male
Middle Aged
Neoplasm Staging
Propensity Score
Sex Factors
Sociological Factors
Survival Rate
Treatment Refusal
/ statistics & numerical data
United States
colon cancer
disparities
race
refusal
treatment
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
11
02
2020
accepted:
14
03
2020
pubmed:
1
4
2020
medline:
11
6
2020
entrez:
1
4
2020
Statut:
ppublish
Résumé
Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer. The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts. A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001). There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer.
METHODS
METHODS
The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts.
RESULTS
RESULTS
A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001).
CONCLUSIONS
CONCLUSIONS
There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1306-1313Informations de copyright
© 2020 Wiley Periodicals, Inc.
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