Factors associated with refusal of radiotherapy among oral cancer patients

Abstract

Background: Surgery is commonly favored in the management of oral cancer but radiotherapy may be essential because of the size or location of the tumor. Refusal of radiotherapy by patients is an important issue, which must be taken into consideration during treatment planning. This study assessed prevalence and correlates of radiotherapy refusal among oral cancer patients. Methods: Data was analyzed for 47, 174 oral cancer cases in the Surveillance, Epidemiology and End Results (SEER) database during 1988–2008. Point estimates were calculated overall and by selected socio-demographic and clinical characteristics. A multivariate logistic regression model was fitted to determine predictors of radiotherapy refusal. Results: The overall prevalence of refusal of radiotherapy was 2.31%. Factors associated with increased likelihood of refusal of radiotherapy included age 45 years (adjusted odds ratio, aOR2.48; P0.031); gingival/floor of mouth tumors (aOR1.32; P0.010); receipt of surgery (aOR1.21; P0.04). Conversely, protective factors included being married (aOR0.59; P0.001); non-Hispanic blacks (aOR0.53; P0.001); involvement of paired structures (aOR0.61; P0.001) as well as multiple tumors (aOR0.75; P0.021). Sex was not a significant predictor on multivariate analysis. Conclusion: Prevalence of refusal of radiotherapy among oral cancer patients is relatively low and is significantly associated with age, marital status, as well as location, extent and severity of disease. Clinicians may anticipate patients likely to refuse radiotherapy and develop patient-tailored counseling considering the benefits and risks of proposed treatment. Final treatment decision must however take into consideration the wishes of the fully informed patient.