Factors predicting for patient refusal of head and neck cancer therapy.
BACKGROUND
The purpose of this study was to evaluate the national rate of treatment refusal in head and neck cancer (HNC).


METHODS
The National Cancer Database was queried for nonmetastatic squamous cell carcinoma of the head and neck. Oncologic therapy referred to receipt of surgery, radiotherapy, or chemotherapy.


RESULTS
Compared to the 230 424 patients who received treatment, 2965 (1.3%) were reported to have refused definitive therapy. Predictors included older age, female sex, African-American/other race, nonprivate insurance, greater comorbidities, more advanced disease, and residence closer to the treating facility (P < .05). Patients with a prior history of cancer, Hispanic race, those treated at academic centers, and those from higher income counties were less likely to refuse therapy (P < .05). Patients who refused definitive therapy experienced poorer survival (median 79.1 vs 8.7 months, P < .001).


CONCLUSIONS
Refusing oncologic therapy is relatively rare in HNC and appears to be multifocal in nature.
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D001741:African Americans D000368:Aged D002294:Carcinoma, Squamous Cell D016208:Databases, Factual D005260:Female D006258:Head and Neck Neoplasms D006801:Humans D016312:Treatment Refusal
head and neck cancer treatment refusal surgery radiotherapy definitive treatment radiation socioeconomic factors