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What Happens After Declining Recommended Surgery? Analysis of Early-Stage Non-Small Cell Lung Cancer
Clayton J Agler1, Catherine G Pratt1, Jenna N Whitrock1
1Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Annals of Thoracic Surgery Short Reports
|December 22, 2025
Summary
Most patients with early-stage non-small cell lung cancer (NSCLC) who decline surgery also decline all treatment, leading to worse survival. Addressing socioeconomic barriers is crucial for improving lung cancer care.
Area of Science:
- Oncology
- Thoracic Surgery
- Public Health
Background:
- Surgery offers curative treatment for early-stage non-small cell lung cancer (NSCLC).
- A subset of patients decline recommended surgery, impacting overall survival (OS).
- Understanding treatment patterns post-surgery declination is vital.
Purpose of the Study:
- To identify factors associated with declining all treatment among NSCLC patients who refuse recommended surgery.
- To analyze survival outcomes based on treatment choices after declining surgery.
Main Methods:
- Utilized the National Cancer Database (2004-2020) for Stage I-II NSCLC patients ≤70 years.
- Created two cohorts: declined surgery but received alternative treatment, and declined surgery and all other treatments.
- Employed Cox regression to identify factors associated with OS.
Main Results:
- Of 923 patients declining surgery, 70.6% received no further treatment.
- Patients declining all treatment were more likely to have Stage I NSCLC and non-government insurance.
- Higher income areas and receiving alternative treatment correlated with improved OS; increased comorbidities worsened OS.
Conclusions:
- The majority of patients refusing NSCLC surgery also forgo other treatments, correlating with poorer OS.
- Socioeconomic factors significantly influence treatment decisions and outcomes in NSCLC.
- Targeted interventions are needed to overcome barriers to lung cancer treatment.
