Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease

Isaac G Alty; Edward Christopher Dee; James C Cusack; Lawrence S Blaszkowsky; Robert N Goldstone; Todd D Francone; Jennifer Y Wo; Motaz Qadan

doi:10.1016/j.amjsurg.2020.06.020

Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease

Am J Surg. 2021 Jan;221(1):39-45. doi: 10.1016/j.amjsurg.2020.06.020. Epub 2020 Jun 23.

Authors

Isaac G Alty¹, Edward Christopher Dee¹, James C Cusack², Lawrence S Blaszkowsky³, Robert N Goldstone⁴, Todd D Francone⁴, Jennifer Y Wo⁵, Motaz Qadan⁶

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA.
⁴ Newton-Wellesley Hospital, Newton, MA, USA.
⁵ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA.
⁶ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA. Electronic address: mqadan@mgh.harvard.edu.

PMID: 32723488
DOI: 10.1016/j.amjsurg.2020.06.020

Abstract

Background: We aimed to identify factors associated with refusal of surgery among patients with colon cancer.

Methods: This 2004-2016 NCDB retrospective study identified AJCC stage I-III colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders.

Results: Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival.

Conclusions: Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making.

Keywords: Cancer; Colon; Disparities; NCDB; Refusal; Surgery.

MeSH terms

Adolescent
Adult
Aged
Colonic Neoplasms / mortality*
Colonic Neoplasms / surgery*
Female
Healthcare Disparities / statistics & numerical data*
Humans
Male
Middle Aged
Retrospective Studies
Survival Rate
Treatment Refusal / statistics & numerical data*
United States / epidemiology
Young Adult