Trends in Racial and Ethnic Differences in Declined Surgery for Resectable Malignancies in the United States

To assess trends in patients' decisions to decline cancer surgery in the United States by race and ethnicity.

Racial and ethnic differences in declining potentially curative cancer surgery are suggested to be due to systemic inequities in health care access and mistrust of health care systems, among other factors. Despite ongoing national efforts to address these inequities, it is unknown whether differences in rates of declined cancer surgery have improved.

Using population-based data from the U.S. Surveillance, Epidemiology, and End Results program from 2000 to 2019, we studied individuals with nonmetastatic cancer who were recommended surgery. Racial and ethnic differences in risk-adjusted rates of declined surgery were evaluated by year and cancer site using mixed-effect logistic regression.

Of 2,740,129 patients with resectable, nonmetastatic cancer, Black patients had the highest rates of declined surgery [2.10% (95% CI: 1.91% to 2.31%)], whereas White patients had the lowest [1.04% (95% CI: 0.95% to 1.14%)]. From 2000 to 2019, racial and ethnic differences in declined surgery did not change significantly, except for a decrease in the difference between Hispanic and White patients [difference-in-difference, -0.4% (95% CI: -0.71% to -0.09%)]. When stratified by cancer site, Black-White differences in rates of declined surgery decreased significantly (but were not eliminated) for 4 of 15 sites (esophageal, pancreatic, lung, and kidney; P < 0.001).

Patients from racial and ethnic minority groups were more likely to decline surgical intervention for potentially curable malignancies, and these differences have persisted over time. Further work is needed to understand the causes of these differences and identify opportunities for improvement.