Correlates of Refusal of Surgery in the Treatment of Non-metastatic Pancreatic Adenocarcinoma

Annals of Surgical Oncology
Alex CoffmanShane Lloyd

Abstract

Surgical resection is the most important therapeutic intervention for eligible patients with pancreatic cancer; however, a majority of patients never receive surgery for a variety of reasons, including patient refusal. Utilizing the National Cancer Database, we investigated the associated sociodemographic and clinical factors for those patients who refused surgery, and the impact of this decision on overall survival (OS). We analyzed adult patients with non-metastatic adenocarcinoma of the pancreas diagnosed from 2004 to 2013. Univariate and multivariate logistic regression modeling was used to identify factors predictive of refusing surgery, and Kaplan-Meier and log-rank analysis was performed to investigate the effect on OS. A total of 48,902 patients were identified: 47,107 received surgery (96.3%) and 1795 were offered surgery but refused (3.7%). Factors associated with refusing surgery include both sociodemographic factors [age > 50 years, female sex, Black race, non-private insurance, treatment at a non-academic institution or non-metro facility, Carlson Comorbidity Index of 2 + (p ≤ 0.01)], and clinical factors [advanced clinical T (tumor) category and tumor size > 20 cm (p ≤ 0.01)]. Patients who refused surgery and rece...Continue Reading

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Citations

Jul 11, 2020·Annals of Surgical Oncology·Matthew ParsonsRanda Tao
Jul 28, 2020·The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association·Joel E SegelNiraj J Gusani
Apr 1, 2020·Journal of Surgical Oncology·Pamela W LuNelya Melnitchouk
Feb 25, 2020·Journal of Surgical Oncology·Adam C FieldsNelya Melnitchouk
Nov 9, 2018·Annals of Surgical Oncology·Nicholas Latchana, Natalie Coburn
Nov 25, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Rayyan S MirdadTimothy M Pawlik
Jan 12, 2021·Urologic Oncology·Ahmed ElshabrawyAhmed M Mansour
Feb 26, 2021·JCO Oncology Practice·Edward Christopher DeeVinayak Muralidhar
Mar 18, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Maxime CollardFrançois Paye
Dec 20, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Caroline WilliamssonBodil Andersson
Sep 2, 2021·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Kavin SugumarLee M Ocuin

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