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

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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.


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.


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.”


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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The authors thank MedCom for assistance with English editing.


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

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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, Y., Lee, S., Liao, C. 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).

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  • Head and neck cancer
  • Treatment adherence and compliance
  • Therapeutic compliance
  • Patient noncompliance
  • Interdisciplinary health team
  • Medical care team