Volume 129, Issue 6 pp. 1368-1373

Head and Neck

Refusal of Cancer-Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

Meghan M. Crippen MD,

Meghan M. Crippen MD

orcid.org/0000-0001-5531-2552

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Marcus L. Elias BS,

Marcus L. Elias BS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Joseph S. Weisberger MS,

Joseph S. Weisberger MS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Jacob S. Brady MD,

Jacob S. Brady MD

orcid.org/0000-0003-0223-1518

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Jean Anderson Eloy MD, FACS,

Jean Anderson Eloy MD, FACS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Soly Baredes MD, FACS,

Soly Baredes MD, FACS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Richard Chan Woo Park MD, FACS,

Corresponding Author

Richard Chan Woo Park MD, FACS

[email protected]

orcid.org/0000-0002-5780-5227

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Send correspondence to Richard Chan Woo Park, MD, Assistant Professor, Head and Neck Oncology/Microvascular Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103. E-mail: [email protected]Search for more papers by this author

Meghan M. Crippen MD,

Meghan M. Crippen MD

orcid.org/0000-0001-5531-2552

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

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Marcus L. Elias BS,

Marcus L. Elias BS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Joseph S. Weisberger MS,

Joseph S. Weisberger MS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Jacob S. Brady MD,

Jacob S. Brady MD

orcid.org/0000-0003-0223-1518

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Jean Anderson Eloy MD, FACS,

Jean Anderson Eloy MD, FACS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Soly Baredes MD, FACS,

Soly Baredes MD, FACS

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Richard Chan Woo Park MD, FACS,

Corresponding Author

Richard Chan Woo Park MD, FACS

[email protected]

orcid.org/0000-0002-5780-5227

Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

First published: 02 August 2018

https://doi.org/10.1002/lary.27116

Citations: 19

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

To investigate the risk factors for refusal of recommended surgery in head and neck squamous cell carcinoma (HNSCC) treatment

Study Design

Retrospective review of a national database.

Methods

The Surveillance, Epidemiology, and End Results database was queried for all cases of HNSCC from 1989 to 2014. Patients who underwent recommended surgery (N = 98,270) were identified and compared to patients who refused recommended surgery (N = 3,582). Groups were compared for patient demographics, socioeconomic variables, and tumor characteristics including stage, grade, and primary site. Binary logistic regression was performed to determine independent predictors of surgery refusal.

Results

Of the total population, 1.8% of patients refused cancer directed surgery. Following regression, the strongest predictors of surgery refusal were found to be age greater than 75years (odds ratio [OR]: 4.23 [95% confidence interval {CI}: 3.00-5.96]), and stage III (OR: 4.19 [95% CI: 3.15-5.57]) or stage IV at diagnosis (OR: 4.49 [95% CI: 3.46-5.80]). Black race was significantly predictive (OR: 1.71 [95% CI: 1.37-2.13]) as well as marital status other than married (OR: 1.76 [95% CI: 1.49-2.07]) and Medicaid insurance status (OR:1.46 [95% CI: 1.20-1.77]). Primary site of larynx (OR: 2.01 [95% CI: 1.71-2.37]) or base of tongue (OR: 2.34 [95% CI: 1.87-2.92]) additionally predicted surgery refusal.

Conclusions

A number of demographic, socioeconomic, and tumor-related variables are associated with refusal of cancer-directed surgery in head and neck squamous cell carcinoma. Recognition of these factors may help identify situations where more active education and support are needed to help patients accept optimal care.

Level of Evidence

Laryngoscope, 129:1368–1373, 2019

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Citing Literature

Volume129, Issue6

June 2019

Pages 1368-1373

Refusal of Cancer-Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Refusal of Cancer-Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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