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  • Author
    Jackelyn Moya
  • Co-author

    Jackelyn J. Moya, MS, MPH; Ashkan Moazzez, MD, MPH; Junko J. Ozao-Choy, MD; Christine Dauphine, MD

  • Title

    Characteristics of Patients with Invasive Breast Cancer that Refuse Recommended Cancer Therapies and the Impact on Overall Survival

  • Abstract

    Introduction:  Completion of surgical resection and (neo)adjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer.

    Objective:  To determine the characteristics of patients that refuse recommended therapies and the impact of refusal on overall survival.

    Participants:  2,058,568 patients with invasive breast cancer in the National Cancer Database, of whom 12,163 (0.6%) refused surgery, 143,492 (7.5%) refused chemotherapy, 66,194 (3.5%) refused radiation, and 86,425 (4.5%) refused endocrine therapy.

    Results: 

     

    Surgery Refusal

    Chemotherapy Refusal

    Radiation Refusal

    Endocrine Refusal

    Female

    NS

    1.44

    NS

    1.13

    Black

    2.23

    0.91

    1.16

    0.92

    Hispanic

    NS

    0.76

    0.79

    0.72

    Uninsured

    3.53

    1.25

    1.71

    1.38

    AJCC Stage

    2.38

    0.42

    1.11

    0.76

    ER-HER2+

    NS

    0.16

    0.94

    NA

    ER+HER2+

    1.11

    0.19

    NS

    NS

    TNBC

    0.65

    0.21

    0.84

    NA

    Age

    1.09

    1.09

    1.06

    1.03

    Distance

    1

    NS

    NS

    NS

    Surgery refusal had the highest hazard ratio for mortality (2.6) compared to chemotherapy (1.3), radiation (1.8), or endocrine therapy (1.5) independent of race, insurance, receptor status, stage.

    Conclusion:  Patients refusing therapy were older and had more medical co-morbidities; they did not live farther from the treating hospital.  Black patients more often refused surgery and radiation; Hispanic patients were less likely to refuse adjuvant therapies.  Uninsured patients were more likely to refuse treatment, particularly surgery. Patients with triple-negative breast cancer were less likely to refuse any treatment. Refusal of recommended surgery has the highest association with mortality in patients with invasive breast cancer, followed by radiation, endocrine therapy, and chemotherapy.

     

  • College

    AAC

  • Zoom

    https://ucla.zoom.us/j/5717302301?pwd=TzUyN1hwZVdNY0VkRXRvM0x0ejErQT09

  • PDF

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