Department of Radiation Oncology, Stanford Medicine, Palo Alto, California.
Department of Radiation Oncology, Stanford Medicine, Palo Alto, California.
Int J Radiat Oncol Biol Phys. 2023 May 1;116(1):96-102. doi: 10.1016/j.ijrobp.2023.01.033. Epub 2023 Feb 9.
Radiation therapy (RT) refusal by patients with cancer is infrequent but is significant because it portends poor outcomes. No prior study has evaluated all five federally defined racial categories with respects to RT refusal. Here we use a large nationally representative population with cancer to determine: 1) which race of patients refuse RT the most and 2) predictive factors for RT refusal by race.
MATERIALS/METHODS: A retrospective study included patients ≥18 years old with diagnostically confirmed cancer between 2004-2017, using the National Cancer Database. All patients included were offered RT for first course treatment. Multivariable logistic regression assessed RT refusal (adjusted odds ratio [aOR]) with 95% confidence intervals (95%CI). Analyses were adjusted for patient factors (age, rurality, income, education, and comorbidities) and cancer characteristics (stage, cancer type, facility type, year of diagnosis, and region). Median overall survival was calculated using the Kaplan-Meier method.
Of 11,609,044 patients, 2,759,753 patients were included and recommended for RT by the treating physician. Median follow-up was 50 months. RT was refused by 139,383 patients (5.0%), varying by race: 416 NHPI (7.2%), 489 AIAN (5.8%), 118,186 Non-Hispanic White (5.0%), 17,427 Black (4.8%), and 2,865 Asian (4.8%) patients. The rates of annual RT refusal were increasing, especially among NHPI patients. The populations with the highest likelihood of refusing RT were NHPI (aOR=1.53, 95%CI=1.36-1.71), AIAN (aOR=1.24, 95%CI=1.12-1.37), and Black (aOR=1.11, 95%CI=1.09-1.14) patients, compared to Non-Hispanic White patients. Older age and higher comorbidity burden predicted RT refusal across all races. Median overall survival was 81 months and 144 months for patients who refused RT and received RT, respectively.
Indigenous and Black patients are more likely to refuse RT, which may contribute to inferior cancer outcomes. Understanding NHPI and AIAN patient perspectives and perceptions may elucidate interventions to mitigate these disparities.
癌症患者拒绝放疗的情况并不常见，但意义重大，因为这预示着预后不良。以前没有研究使用联邦政府定义的所有五个种族类别来评估放疗拒绝的情况。在这里，我们利用一个具有代表性的大型全国癌症患者人群来确定：1）哪种族的患者拒绝放疗的比例最高，2）按种族划分的放疗拒绝的预测因素。
材料/方法：这是一项回顾性研究，纳入了 2004 年至 2017 年间通过国家癌症数据库确诊患有癌症且年龄≥18 岁的患者。所有患者均接受首次治疗的放疗。多变量逻辑回归评估了放疗拒绝率（调整后的优势比[aOR]）及其 95%置信区间（95%CI）。分析调整了患者因素（年龄、农村/城市、收入、教育程度和合并症）和癌症特征（分期、癌症类型、医疗机构类型、诊断年份和地区）。使用 Kaplan-Meier 方法计算中位总生存期。
在 11609044 名患者中，有 2759753 名患者被治疗医生推荐接受放疗。中位随访时间为 50 个月。139383 名患者（5.0%）拒绝了放疗，种族之间存在差异：416 名非裔原住民（7.2%）、489 名美国印第安人/阿拉斯加原住民（5.8%）、118186 名非西班牙裔白人（5.0%）、17427 名黑人（4.8%）和 2865 名亚裔（4.8%）患者。放疗拒绝率呈逐年上升趋势，尤其是非裔原住民患者。拒绝放疗的可能性最高的人群是非裔原住民（aOR=1.53，95%CI=1.36-1.71）、美国印第安人/阿拉斯加原住民（aOR=1.24，95%CI=1.12-1.37）和黑人（aOR=1.11，95%CI=1.09-1.14）患者，而非西班牙裔白人患者。年龄较大和合并症负担较重与所有种族的放疗拒绝相关。拒绝放疗和接受放疗的患者的中位总生存期分别为 81 个月和 144 个月。
原住民和黑人患者更有可能拒绝放疗，这可能导致癌症预后较差。了解非裔原住民和美国印第安人/阿拉斯加原住民患者的观点和看法可能有助于制定减轻这些差异的干预措施。
