Mayo Clinic, Rochester, Minnesota
Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
J Natl Compr Canc Netw. 2016 May;14(5):539-50. doi: 10.6004/jnccn.2016.0062.
To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC).
We identified patients in the National Cancer Data Base diagnosed with EOC from January 1998 to December 2011. Patients who refused chemotherapy were identified and compared with those who received recommended, multiagent chemotherapy. Univariate and multivariable analyses were performed using chi-square test with Bonferroni correction, binary logistic regression, log-rank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05.
From a cohort of 147,713 eligible patients, 2,707 refused chemotherapy. These patients were compared with 92,212 patients who received recommended multiagent chemotherapy. Older age, more medical comorbidities, not having insurance, and later year of diagnosis were directly and significantly associated with chemotherapy refusal when analyzed using multivariable logistic regression. In addition, lower-than-expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at low-volume center, lower grade, and higher stage were all significantly and independently associated with chemotherapy refusal. Median overall survival of patients who received multiagent chemotherapy was significantly longer than that of those who refused chemotherapy (43 vs 4.8 months; P<.0005). After controlling for known patient, facility, and disease prognostic factors, chemotherapy refusal is significantly associated with increased risk of death.
Refusal of recommended chemotherapy carries significant risk of early death from ovarian cancer. Our data demonstrate that the decision to refuse chemotherapy is multifactorial and, in addition to unalterable factors (eg, stage/grade, age), involves factors that can be changed, including facility type and payor. Efforts at addressing these discrepancies in care can improve compliance with chemotherapy recommendations in the NCCN Guidelines for Ovarian Cancer and outcomes.
确定与上皮性卵巢癌（EOC）患者拒绝推荐化疗相关的因素及其对患者的影响。
我们从 1998 年 1 月至 2011 年 12 月的国家癌症数据库中确定了诊断为 EOC 的患者。确定拒绝化疗的患者，并将其与接受推荐的多药化疗的患者进行比较。使用卡方检验（带有 Bonferroni 校正）、二元逻辑回归、对数秩检验和 Cox 比例风险模型进行单变量和多变量分析。统计显著性的阈值设定为 P 值小于 0.05。
从 147713 例合格患者中，有 2707 例拒绝化疗。这些患者与 92212 例接受推荐的多药化疗的患者进行了比较。多变量逻辑回归分析显示，年龄较大、合并更多的医疗合并症、没有保险和较晚的诊断年份与化疗拒绝直接显著相关。此外，设施对 NCCN 肿瘤学临床实践指南（NCCN 指南）中卵巢癌的依从性低于预期、在低容量中心治疗、较低的分级和较高的分期均与化疗拒绝显著且独立相关。接受多药化疗的患者的中位总生存期明显长于拒绝化疗的患者（43 个月比 4.8 个月；P<.0005）。在控制已知的患者、设施和疾病预后因素后，拒绝化疗与死亡风险增加显著相关。
拒绝推荐的化疗会显著增加死于卵巢癌的风险。我们的数据表明，拒绝化疗的决定是多因素的，除了不可改变的因素（例如，分期/分级、年龄）外，还涉及可以改变的因素，包括设施类型和支付方。努力解决这些护理中的差异可以提高对 NCCN 卵巢癌指南中化疗建议的依从性和结局。
