Factors Influencing Refusal of Adjuvant Chemotherapy in Non-Small Cell Lung Carcinoma

Adjuvant chemotherapy is recommended for patients with resectable stage II and IIIA non-small cell lung cancer (NSCLC) and may be considered for high-risk stage I cases. Despite these guidelines, a significant number of patients decline treatment. We hypothesize that socioeconomic factors contribute to adjuvant chemotherapy refusal.

We queried the National Cancer Database (2010-2020) for patients with stage IB-IIIB NSCLC who underwent complete surgical resection. Patients were stratified by receipt of adjuvant chemotherapy. Multivariable logistic regression identified factors associated with chemotherapy refusal. Survival outcomes were analyzed using Kaplan-Meier curves.

Of 47,481 eligible patients, 6701 (14.1%) refused adjuvant chemotherapy. Older patients (age > 75) had higher odds of refusal (OR 5.2, 95% CI, 7.7-3.5). In contrast, Hispanic (OR 0.76, 95% CI, 0.90-0.63) and Black patients (OR 0.86, 95% CI, 0.95-0.78) were less likely to refuse. Higher comorbidity burden (Charlson-Deyo > 3) and lack of insurance increased the likelihood of refusal (OR 1.32 and OR 1.3, respectively). Patients treated at academic centers were less likely to refuse than those at community centers (OR 0.88, 95% CI, 0.93-0.82). No sex-based differences were observed. Refusal was associated with reduced survival (HR 1.1, 95% CI, 1.1-1.01).

Refusal of adjuvant chemotherapy in resectable NSCLC is influenced by age, comorbidities, insurance status, and treatment facility type. These findings highlight the need for targeted strategies to address treatment disparities and improve patient outcomes.