拒绝放疗及其对生存的影响。
Refusal of radiation therapy and its associated impact on survival.
机构信息
Department of Human Oncology, University of Wisconsin, Madison, 53792, USA.
出版信息
Am J Clin Oncol. 2010 Dec;33(6):629-32. doi: 10.1097/COC.0b013e3181d270ce.
OBJECTIVES
Despite evidence that radiation therapy (RT) improves outcome in multiple malignancies, some patients with strong clinical indications still refuse RT. Data on factors associated with RT refusal are limited. Furthermore, the effect of RT refusal on outcome has not been clearly defined.
METHODS
Patients with nonmetastatic cancer, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate methods were used to identify factors associated with RT refusal and the impact of refusal on outcomes.
RESULTS
On univariate analysis, age, sex, marital status, tumor site, and tumor stage were associated with RT refusal (P < 0.001). On multivariate analysis, sex and tumor stage were not found to be associated with RT refusal. In contrast, age, race, marital status, and tumor location were significantly associated with RT refusal. The median survival of compliant patients was 171 months compared with just 96 months among patients who refused RT.
CONCLUSIONS
A significant percentage of patients continue to refuse RT despite medical advice and evidence. Subgroups at particular risk of RT refusal include elderly, black and widowed patients. RT refusal is associated with markedly worse clinical outcomes.
目的
尽管有证据表明放射治疗（RT）可改善多种恶性肿瘤的预后，但仍有部分具有强烈临床指征的患者拒绝接受 RT。有关与 RT 拒绝相关的因素的数据有限。此外，RT 拒绝对结果的影响尚未明确界定。
方法
在监测、流行病学和结果数据库中，确定了 1988 年至 2005 年间诊断为非转移性癌症的患者。使用单变量和多变量方法来确定与 RT 拒绝相关的因素以及拒绝 RT 对结果的影响。
结果
单因素分析显示，年龄、性别、婚姻状况、肿瘤部位和肿瘤分期与 RT 拒绝有关（P<0.001）。多因素分析显示，性别和肿瘤分期与 RT 拒绝无关。相比之下，年龄、种族、婚姻状况和肿瘤部位与 RT 拒绝显著相关。顺从患者的中位生存期为 171 个月，而拒绝 RT 的患者仅为 96 个月。
结论
尽管有医学建议和证据，但仍有相当一部分患者继续拒绝 RT。RT 拒绝风险特别高的亚组包括老年人、黑人以及丧偶患者。RT 拒绝与明显更差的临床结果相关。
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