Refusal of cancer-directed treatment by colon cancer patients: Risk factors and survival outcomes

Abstract Aim Surgery with or without chemotherapy represent the only curative option for patients with colon cancer. However, some patients refuse treatment despite the recommendation. This study aims to identify the incidence, risk factors and impact on survival associated with refusal. Methods A National Cancer Data Base (NCDB) analysis between 1998 and 2012 was performed. We identified 924,290 patients with potentially treatable colon cancer. Patients who underwent treatment were compared with patients that refused. Results 7152 patients refused surgery. On multivariable analysis, patients were more likely to refuse if they were older (OR = 1.14; 95% CI 1.14–1.15), female (OR = 1.20; 95% CI 1.12–1.28), African American (vs White, OR = 2.30; 95% CI 2.10–2.51) or on Medicaid (vs private, OR = 3.06; 95% CI 2.49–43.77). Overall survival was worse in patients that refused surgery [median survival 6.8 vs 24 months, Cox hazard ratio (HR) 3.41; 95%CI 3.12–3.60]. Furthermore, 11,334 patients with path. stage III disease refused adjuvant chemotherapy. Conclusions Refusal of treatment affects survival and is independently associated with several variables (gender, race, insurance status), therefore raising the concern that socioeconomic factors may drive decisions.