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Factors impacting on discordance with treatment plan in head and neck cancer patients: a retrospective, population-based cohort study

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Abstract

Purpose

The aims of this study were to identify the factors and reasons impacting discordance with the treatment plan in head and neck cancer (HNC) patients and compare the differences between the concordance group and the discordance group.

Methods

This secondary analysis was conducted from population-based data from Taiwan collected from January 1, 2016, to June 30, 2018. Logistic regression analysis was used to identify the factors related to discordance with the treatment plan.

Results

We examined 1095 HNC patients, 12.1% of whom were discordant with treatment. Patients with advanced cancer stage, old age, and treatment plans of best supportive care (BSC) or surgery combined with radiation (RT), chemotherapy (CT), or chemoradiation (CCRT) were more likely to have discordance with their treatment plan. Of the 133 patients who were discordant with their treatment plan, the top reasons were as follows: “patients or their family considered patients’ poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment,” “inconvenient transportation,” and “disease progression.”

Conclusions

Patients’ cancer stage, age, and types of treatment plans recommended significantly influenced discordance with treatment plan. Poor physical condition was the major reason for discordance with the treatment plan. Patients in the concordance group were significantly more likely than those in the discordance group to be younger than 65 years, have less advanced cancer stage, and be recommended to receive surgery rather than any other regimen. Multidisciplinary team care can help patients make positive decisions about treatment.

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Acknowledgments

The authors thank MedCom for assistance with English editing.

Funding

This study was supported by a grant from Chang Gung Memorial Hospital (Grant/Award Number: CMRPG3J0241) Research Program in Taiwan.

Author information

Authors and Affiliations

  1. Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Ya-Lan Chang, Chao-Hui Wang & Yu-Fen Lin

  2. Department of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Ya-Lan Chang & Chao-Hui Wang

  3. Cancer Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shu-Chu Lee

  4. Departments of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Chun-Ta Liao

  5. School of Nursing, College of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Road, Kweishan, Taoyuan, 333, Taiwan

    Shu-Ching Chen

  6. Department of Radiation Oncology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shu-Ching Chen

  7. Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shu-Ching Chen

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  1. Ya-Lan Chang
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Corresponding author

Correspondence to Shu-Ching Chen.

Ethics declarations

The study was approved by the Institutional Review Board of Chang Gung Medical Foundation Institutional Review Board in Taiwan, and a permission certificate was obtained (Number: 201900232B0).

Conflict of interest

The authors declare that they have no competing interests.

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Informed consent was obtained from all individual participants included in the study.

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Chang, YL., Lee, SC., Liao, CT. et al. Factors impacting on discordance with treatment plan in head and neck cancer patients: a retrospective, population-based cohort study. Support Care Cancer 28, 951–958 (2020). https://doi.org/10.1007/s00520-019-04904-z

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  • DOI: https://doi.org/10.1007/s00520-019-04904-z

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