Author of

• 16879

  +

  P1.07 - Poster Session with Presenters Present (ID 459)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: SCLC/Neuroendocrine Tumors
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16926

    +

    P1.07-047 - Refusal of Chemoradiotherapy and Chemotherapy among SCLC Patients: Analysis of US National Facility-Based Data (ID 5360)

    14:30 - 14:30  |  Author(s): P.E. Deviany
    • Abstract

    Background:
    Less than 7% of small cell lung cancer (SCLC) patients survive five years after diagnosis. Although receipt of recommended treatment is a key to survival, factors associated with treatment refusal have not been well studied in SCLC. Our study examined factors associated with treatment refusal by SCLC patients and effect of refusal on survival.
    
    Methods:
    We analyzed data of 114,004 SCLC patients diagnosed between 2003 and 2012 from the National Cancer Data Base. Analyses were conducted separately for refusal of chemoradiotherapy among limited stage (LS) and refusal of chemotherapy among extensive stage (ES) patients. We used multivariable logistic regression to investigate factors associated with treatment refusal and calculated median survival using Kaplan-Meier method.
    
    Results:
    There was a female preponderance among LS (56%), whereas 52% of ES patients were male (p <.001). Majority of the LS patients received chemoradiotherapy (67%), and ES patients received chemotherapy only (44%) as their first-course treatment. Refusal of chemoradiotherapy among LS patients was 2%, and refusal of chemotherapy among ES patients was 5%. On multivariable analysis, patient diagnosed at age >70 years were more likely to refuse treatment compared to those age 50-70 years; the adjusted odds ratio (AOR) was 3.39 (95% CI: 2.68-4.28) for refusal of chemoradiotherapy among LS patients and 2.54 (95% CI: 2.28-2.84) for refusal of chemotherapy among ES patients. Females were more likely to refuse recommended treatment than males, the AOR was 1.34 (95% CI: 1.09-1.65) for refusal of chemoradiotherapy and 1.29 (95% CI: 1.17-1.42) for refusal of chemotherapy. Compared to those with private insurance, uninsured patients were more likely to refuse chemoradiotherapy (AOR= 2.70, 95% CI: 1.49-4.91) and chemotherapy (AOR=2.26, 95% CI: 1.76-2.91). Patients with comorbid conditions were more likely to refuse recommended treatment compared to those without comorbidity; the AOR was 1.66 (95% CI: 1.33-2.07) for refusal of chemoradiotherapy and 1.37 (95% CI: 1.23-1.53) for refusal of chemotherapy. Median survival of LS patients who received and refused chemoradiotherapy was 18 and 3 months respectively (p <.001). Among ES patients, median survival was 8 months for those who received chemotherapy and 1 month for those who refused (p <.001).
    
    Conclusion:
    Although treatment refusal was uncommon, older age at diagnosis, female, uninsured status, and comorbid conditions were associated with higher treatment refusal. These factors should be specially addressed in patient-provider communication and patient-education. Interventions targeting these issues will increase acceptance of recommended treatment and ultimately will improve patient outcomes.