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Survival Impact and Sociodemographic Correlates of Colon Cancer Surgery Refusal
Paola Berrios Jimenez1, Angel Aguayo Merly2, Ramin Shekouhi3
1School of Medicine, University of Puerto Rico, San Juan, PR, U.S.A.; paola.berrios2@upr.edu.
Background/Aim:
Surgical treatment for colon cancer is often curative when diagnosed early. This study evaluated the sociodemographic characteristics and survival outcomes associated with refusal of surgery among patients with colon cancer. The objective was to identify disparities to improve patient outcomes.
Patients And Methods:
We conducted a retrospective cohort study using National Cancer Data Base (NCDB) data from 2004 to 2019, including 1,048,575 patients with colon cancer. Variables analyzed included demographics, tumor characteristics, treatment facility type, and geographic and socioeconomic factors. Descriptive statistics were assessed using Wilcoxon Rank Sum and Chi-square tests. Survival outcomes were evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards regression.
Results:
Among 1,048,575 patients with colon cancer, 87.6% underwent surgery, 11.5% did not due to treatment plan decisions, comorbidities, or unknown reasons, and 1.0% refused surgery. The mean age of those who refused surgery was 80.8 years, compared to 68.1 years overall. Surgery refusal was more common among females (61.4%), Black patients (16.6%), individuals with non-private insurance (87.3%), and those from metropolitan areas (77.4%). Survival outcomes significantly differed by surgical status (p<0.001). Patients who underwent surgery had the highest five-year survival (66%) and median survival (82.3 months), while those who refused surgery had a five-year survival of 55% and median survival of 66.1 months.
Conclusion:
Sociodemographic factors such as older age, Black race, female sex, lower income, non-private insurance, and non-Hispanic ethnicity were associated with higher refusal rates. Patients who refused surgery had lower five-year survival (55%) compared to those who underwent surgery (66%), underscoring the survival benefit of surgical intervention. These findings highlight the need for targeted efforts to reduce treatment disparities and improve education on treatment outcomes.
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