Abstract
Introduction
Colon cancer is the third leading cause of cancer-related deaths. Although there have been numerous advancements in treatment options, electing to undergo surgery is a difficult decision, and some patients may be hesitant to undergo surgery. We sought to understand the risk factors associated with refusal of surgery and predictors of mortality in patients with colon cancer.
Methods
We retrospectively reviewed the Surveillance, Epidemiology, and End Results database for patients diagnosed with colon cancer from 1995 to 2015. We stratified patients according to whether they underwent surgery or refused recommended surgery. We analyzed numerous demographic, surgical, and oncologic variables and performed univariate analysis to assess predictors for refusal of surgery as well as survival and mortality risk in those refusing surgery.
Results
Our analysis included 288,322 patients with primary colon cancer where 284,591 (98.7%) underwent cancer-direct surgery and 3731 (1.3%) refused recommended surgery. Those refusing cancer directed surgery were more likely to be > 70 years old, non-Hispanic black patients, and have distant staged cancer (all p < 0.001). In those refusing surgery, risks for mortality included older age, female gender, widowhood, higher grade or distant-staged cancer, and a positive CEA.
Conclusions
Disparities in care related to patient race, gender, and insurance status were related to patients who refused surgical interventions. This study helps to identify patients who are more likely to refuse surgery and may assist in navigating conversations with patients who are contemplating treatment options.
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Acknowledgment
The authors acknowledge the National Cancer Institute’s (NCI) efforts put forth toward the Surveillance Epidemiology and End Results database, without which this study would not be feasible. The data analysis and the interpretation of the data are the authors alone and do not reflect those of the NCI.
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This study was conducted at Cooper University Hospital, Department of Surgery at One Cooper Plaza Suite 410, Camden, NJ 08103.
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Makar, G.S., Makar, M., Obinero, C. et al. Refusal of Cancer-Directed Surgery in Patients with Colon Cancer: Risk Factors of Refusal and Survival Data. Ann Surg Oncol 28, 606–616 (2021). https://doi.org/10.1245/s10434-020-08783-1
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DOI: https://doi.org/10.1245/s10434-020-08783-1