Influence of Sociodemographic Factors on Treatment Decisions in Non–Small-Cell Lung Cancer

Narjust Duma, Dame W. Idossa, Urshila Durani, Ryan D. Frank, Jonas Paludo, Gustavo Westin, Yanyan Lou, Aaron S. Mansfield, Alex A. Adjei, Ronald S. Go, Sikander Ailawadhi

Research output: Contribution to journalArticle

Abstract

Introduction: In stage IV non–small-cell lung cancer (NSCLC), survival has significantly improved. Despite such trends, it has been noted that patients frequently refuse treatment. Therefore, we explored the factors associated with treatment refusal in NSCLC. Patients and Methods: Utilizing the National Cancer Data Base (NCDB), we identified all stage IV NSCLC cases from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. Results: A total of 341,993 patients were identified; 5.4% of patients refused radiotherapy and 10.3% refused chemotherapy despite provider recommendations. The proportion of patients refusing radiotherapy and chemotherapy increased over time from 4.2% to 7.3% and 7.9% to 15%, respectively (P <.001). In multivariable analysis, men were less likely to refuse treatment compared to women (respectively, odds ratio = 0.80; 95% confidence interval, 0.76–0.84; P <.001; odds ratio = 0.82; 95% confidence interval, 0.80–0.85; P <.001, respectively). Factors associated with radiotherapy refusal included: Medicaid or Medicare as primary insurance, uninsured status, low household median income, and lower educational level. Regarding chemotherapy, uninsured patients, Medicaid patients, and patients with a high comorbidity index were more likely to refuse chemotherapy. Asians had lower rates of chemotherapy refusal relative to non-Hispanic whites. Non-Hispanic whites, Hispanics, and Asians had increasing chemotherapy refusal rates over time, while non-Hispanic blacks had less pronounced trends over time. Conclusion: Socioeconomic factors rather than race/ethnicity appear to influence the refusal of cancer treatment in patients with stage IV NSCLC. Assessing socioeconomic challenges should be an essential part of patient evaluation when discussing treatment options.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Jan 1 2019

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Non-Small Cell Lung Carcinoma
Treatment Refusal
Drug Therapy
Therapeutics
Radiotherapy
Medicaid
Logistic Models
Odds Ratio
Confidence Intervals
Neoplasms
Insurance Coverage
Medicare
Hispanic Americans
Comorbidity
Databases
Survival

Keywords

  • Cancer care
  • Cancer disparities
  • Financial challenges
  • Geriatric oncology
  • Treatment refusal

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Influence of Sociodemographic Factors on Treatment Decisions in Non–Small-Cell Lung Cancer. / Duma, Narjust; Idossa, Dame W.; Durani, Urshila; Frank, Ryan D.; Paludo, Jonas; Westin, Gustavo; Lou, Yanyan; Mansfield, Aaron S.; Adjei, Alex A.; Go, Ronald S.; Ailawadhi, Sikander.

In: Clinical Lung Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Duma, Narjust ; Idossa, Dame W. ; Durani, Urshila ; Frank, Ryan D. ; Paludo, Jonas ; Westin, Gustavo ; Lou, Yanyan ; Mansfield, Aaron S. ; Adjei, Alex A. ; Go, Ronald S. ; Ailawadhi, Sikander. / Influence of Sociodemographic Factors on Treatment Decisions in Non–Small-Cell Lung Cancer. In: Clinical Lung Cancer. 2019.
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abstract = "Introduction: In stage IV non–small-cell lung cancer (NSCLC), survival has significantly improved. Despite such trends, it has been noted that patients frequently refuse treatment. Therefore, we explored the factors associated with treatment refusal in NSCLC. Patients and Methods: Utilizing the National Cancer Data Base (NCDB), we identified all stage IV NSCLC cases from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. Results: A total of 341,993 patients were identified; 5.4{\%} of patients refused radiotherapy and 10.3{\%} refused chemotherapy despite provider recommendations. The proportion of patients refusing radiotherapy and chemotherapy increased over time from 4.2{\%} to 7.3{\%} and 7.9{\%} to 15{\%}, respectively (P <.001). In multivariable analysis, men were less likely to refuse treatment compared to women (respectively, odds ratio = 0.80; 95{\%} confidence interval, 0.76–0.84; P <.001; odds ratio = 0.82; 95{\%} confidence interval, 0.80–0.85; P <.001, respectively). Factors associated with radiotherapy refusal included: Medicaid or Medicare as primary insurance, uninsured status, low household median income, and lower educational level. Regarding chemotherapy, uninsured patients, Medicaid patients, and patients with a high comorbidity index were more likely to refuse chemotherapy. Asians had lower rates of chemotherapy refusal relative to non-Hispanic whites. Non-Hispanic whites, Hispanics, and Asians had increasing chemotherapy refusal rates over time, while non-Hispanic blacks had less pronounced trends over time. Conclusion: Socioeconomic factors rather than race/ethnicity appear to influence the refusal of cancer treatment in patients with stage IV NSCLC. Assessing socioeconomic challenges should be an essential part of patient evaluation when discussing treatment options.",
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T1 - Influence of Sociodemographic Factors on Treatment Decisions in Non–Small-Cell Lung Cancer

AU - Duma, Narjust

AU - Idossa, Dame W.

AU - Durani, Urshila

AU - Frank, Ryan D.

AU - Paludo, Jonas

AU - Westin, Gustavo

AU - Lou, Yanyan

AU - Mansfield, Aaron S.

AU - Adjei, Alex A.

AU - Go, Ronald S.

AU - Ailawadhi, Sikander

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: In stage IV non–small-cell lung cancer (NSCLC), survival has significantly improved. Despite such trends, it has been noted that patients frequently refuse treatment. Therefore, we explored the factors associated with treatment refusal in NSCLC. Patients and Methods: Utilizing the National Cancer Data Base (NCDB), we identified all stage IV NSCLC cases from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. Results: A total of 341,993 patients were identified; 5.4% of patients refused radiotherapy and 10.3% refused chemotherapy despite provider recommendations. The proportion of patients refusing radiotherapy and chemotherapy increased over time from 4.2% to 7.3% and 7.9% to 15%, respectively (P <.001). In multivariable analysis, men were less likely to refuse treatment compared to women (respectively, odds ratio = 0.80; 95% confidence interval, 0.76–0.84; P <.001; odds ratio = 0.82; 95% confidence interval, 0.80–0.85; P <.001, respectively). Factors associated with radiotherapy refusal included: Medicaid or Medicare as primary insurance, uninsured status, low household median income, and lower educational level. Regarding chemotherapy, uninsured patients, Medicaid patients, and patients with a high comorbidity index were more likely to refuse chemotherapy. Asians had lower rates of chemotherapy refusal relative to non-Hispanic whites. Non-Hispanic whites, Hispanics, and Asians had increasing chemotherapy refusal rates over time, while non-Hispanic blacks had less pronounced trends over time. Conclusion: Socioeconomic factors rather than race/ethnicity appear to influence the refusal of cancer treatment in patients with stage IV NSCLC. Assessing socioeconomic challenges should be an essential part of patient evaluation when discussing treatment options.

AB - Introduction: In stage IV non–small-cell lung cancer (NSCLC), survival has significantly improved. Despite such trends, it has been noted that patients frequently refuse treatment. Therefore, we explored the factors associated with treatment refusal in NSCLC. Patients and Methods: Utilizing the National Cancer Data Base (NCDB), we identified all stage IV NSCLC cases from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. Results: A total of 341,993 patients were identified; 5.4% of patients refused radiotherapy and 10.3% refused chemotherapy despite provider recommendations. The proportion of patients refusing radiotherapy and chemotherapy increased over time from 4.2% to 7.3% and 7.9% to 15%, respectively (P <.001). In multivariable analysis, men were less likely to refuse treatment compared to women (respectively, odds ratio = 0.80; 95% confidence interval, 0.76–0.84; P <.001; odds ratio = 0.82; 95% confidence interval, 0.80–0.85; P <.001, respectively). Factors associated with radiotherapy refusal included: Medicaid or Medicare as primary insurance, uninsured status, low household median income, and lower educational level. Regarding chemotherapy, uninsured patients, Medicaid patients, and patients with a high comorbidity index were more likely to refuse chemotherapy. Asians had lower rates of chemotherapy refusal relative to non-Hispanic whites. Non-Hispanic whites, Hispanics, and Asians had increasing chemotherapy refusal rates over time, while non-Hispanic blacks had less pronounced trends over time. Conclusion: Socioeconomic factors rather than race/ethnicity appear to influence the refusal of cancer treatment in patients with stage IV NSCLC. Assessing socioeconomic challenges should be an essential part of patient evaluation when discussing treatment options.

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KW - Cancer disparities

KW - Financial challenges

KW - Geriatric oncology

KW - Treatment refusal

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