Analysis of patients who decline treatment for squamous cell carcinoma of the head and neck: National perspective.

Abstract

To analyze demographic and socioeconomic factors that influence patients' decisions to decline treatment for head and neck squamous cell carcinoma (SCC). Retrospective cohort analysis utilizing the National Cancer Data Base of patients with oral cavity/oropharyngeal, hypopharyngeal, and laryngeal SCC. A total of 166 204 patients were included, of which 689 patients declined all treatment. Among early-stage (I-II) patients, Charlson/Deyo score ≥ 3, hypopharyngeal cancer, and no insurance or Medicare were more likely to decline all recommended treatment (P < .05). Among advanced stage (III-IV) patients, females (odds ratio 1.27, 95% confidence interval 1.05-1.53; P = .013), Charlson Deyo score ≥ 1, non-oral cavity cancers, and closer distance between patient's area of residence from treating facility were more likely to decline all treatment (P < .05). Female patients and patients with no insurance, Medicare, or Medicaid are more likely to decline recommended treatment for SCC of the head and neck. Educational status is not predictive of declining treatment.