Refusal of recommended chemotherapy for ovarian cancer

Risk factors and outcomes; A national cancer data base study

Sumer K. Wallace, Jeff F. Lin, William A. Cliby, Gary S Leiserowitz, Ana I. Tergas, Robert E. Bristow

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). Methods: 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, logrank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. Results: 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, lowerthan- expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at lowvolume 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)539-550
Number of pages12
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume14
Issue number5
StatePublished - May 1 2016

Fingerprint

Ovarian Neoplasms
Databases
Drug Therapy
Neoplasms
Logistic Models
Guidelines
Age Factors
Delayed Diagnosis
Chi-Square Distribution
Insurance
Practice Guidelines
Comorbidity

ASJC Scopus subject areas

  • Oncology

Cite this

Refusal of recommended chemotherapy for ovarian cancer : Risk factors and outcomes; A national cancer data base study. / Wallace, Sumer K.; Lin, Jeff F.; Cliby, William A.; Leiserowitz, Gary S; Tergas, Ana I.; Bristow, Robert E.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 14, No. 5, 01.05.2016, p. 539-550.

Research output: Contribution to journalArticle

Wallace, Sumer K. ; Lin, Jeff F. ; Cliby, William A. ; Leiserowitz, Gary S ; Tergas, Ana I. ; Bristow, Robert E. / Refusal of recommended chemotherapy for ovarian cancer : Risk factors and outcomes; A national cancer data base study. In: JNCCN Journal of the National Comprehensive Cancer Network. 2016 ; Vol. 14, No. 5. pp. 539-550.
@article{f081702eb46a431ca162842b9e583ec6,
title = "Refusal of recommended chemotherapy for ovarian cancer: Risk factors and outcomes; A national cancer data base study",
abstract = "Objective: To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). Methods: 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, logrank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. Results: 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, lowerthan- expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at lowvolume 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. Conclusions: 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.",
author = "Wallace, {Sumer K.} and Lin, {Jeff F.} and Cliby, {William A.} and Leiserowitz, {Gary S} and Tergas, {Ana I.} and Bristow, {Robert E.}",
year = "2016",
month = "5",
day = "1",
language = "English (US)",
volume = "14",
pages = "539--550",
journal = "Journal of the National Comprehensive Cancer Network : JNCCN",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "5",

}

TY - JOUR

T1 - Refusal of recommended chemotherapy for ovarian cancer

T2 - Risk factors and outcomes; A national cancer data base study

AU - Wallace, Sumer K.

AU - Lin, Jeff F.

AU - Cliby, William A.

AU - Leiserowitz, Gary S

AU - Tergas, Ana I.

AU - Bristow, Robert E.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Objective: To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). Methods: 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, logrank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. Results: 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, lowerthan- expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at lowvolume 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. Conclusions: 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.

AB - Objective: To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). Methods: 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, logrank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. Results: 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, lowerthan- expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at lowvolume 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. Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=84968877320&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84968877320&partnerID=8YFLogxK

M3 - Article

VL - 14

SP - 539

EP - 550

JO - Journal of the National Comprehensive Cancer Network : JNCCN

JF - Journal of the National Comprehensive Cancer Network : JNCCN

SN - 1540-1405

IS - 5

ER -