TY - JOUR
T1 - Consequences of Refusing Surgery for Esophageal Cancer
T2 - A National Cancer Database Analysis
AU - Rahouma, Mohamed
AU - Harrison, Sebron
AU - Kamel, Mohamed
AU - Nasar, Abu
AU - Lee, Benjamin
AU - Port, Jeffrey
AU - Altorki, Nasser
AU - Stiles, Brendon
N1 - Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/11
Y1 - 2018/11
N2 - Background: Given the potential morbidity of esophagectomy, patients may pursue other treatments. We sought to determine predictors and outcomes of esophageal cancer patients who refused esophagectomy. Methods: The National Cancer Database (2004 to 2014) was queried for locally advanced esophageal cancer patients. A unique field allows identification of patients recommended to have surgery but who refused. Comparisons between the entire cohort and between propensity matched groups were performed using analysis of variance and χ2 tests. Survival was compared using Kaplan-Meier curves. Logistic regression was performed to identify predictors of refusing surgery. Results: We identified 18,459 patients with esophageal cancer meeting criteria, including 708 (3.8) who were recommended but refused surgery. By multivariate analysis, elderly, female, nonwhite race, squamous histology, early year of diagnosis, absence of insurance, treatment at nonacademic centers, lower income, and clinical stage I/II predicted refusal of surgery. Median survival was worse for patients who refused surgery compared with patients undergoing surgery. Among propensity matched groups (n = 525 each), median survival was better for patients undergoing surgery versus patients who refused (32 versus 21 months, p < 0.001). Conclusions: Although patients may be reluctant to undergo esophagectomy for esophageal cancer, refusal of surgery when offered comes at the expense of decreased survival. These data allow for a discussion of alternative outcomes with those patients in the context of shared decision making.
AB - Background: Given the potential morbidity of esophagectomy, patients may pursue other treatments. We sought to determine predictors and outcomes of esophageal cancer patients who refused esophagectomy. Methods: The National Cancer Database (2004 to 2014) was queried for locally advanced esophageal cancer patients. A unique field allows identification of patients recommended to have surgery but who refused. Comparisons between the entire cohort and between propensity matched groups were performed using analysis of variance and χ2 tests. Survival was compared using Kaplan-Meier curves. Logistic regression was performed to identify predictors of refusing surgery. Results: We identified 18,459 patients with esophageal cancer meeting criteria, including 708 (3.8) who were recommended but refused surgery. By multivariate analysis, elderly, female, nonwhite race, squamous histology, early year of diagnosis, absence of insurance, treatment at nonacademic centers, lower income, and clinical stage I/II predicted refusal of surgery. Median survival was worse for patients who refused surgery compared with patients undergoing surgery. Among propensity matched groups (n = 525 each), median survival was better for patients undergoing surgery versus patients who refused (32 versus 21 months, p < 0.001). Conclusions: Although patients may be reluctant to undergo esophagectomy for esophageal cancer, refusal of surgery when offered comes at the expense of decreased survival. These data allow for a discussion of alternative outcomes with those patients in the context of shared decision making.
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U2 - 10.1016/j.athoracsur.2018.06.030
DO - 10.1016/j.athoracsur.2018.06.030
M3 - Article
C2 - 30055137
AN - SCOPUS:85054140040
SN - 0003-4975
VL - 106
SP - 1476
EP - 1483
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -