Refusal of Definitive Care Among Patients With Salivary Gland Malignancies

We sought to identify predictors of refusal of the recommended operation and, secondarily, radiation therapy refusal, and their associations with cause-specific survival.

A retrospective cohort study using the SEER 17 Registries database (2000-2022) included patients with malignant salivary gland tumors. The primary outcome was refusal of the recommended operation; radiation therapy refusal was the secondary outcome. Multivariable logistic regression identified independent predictors and Kaplan-Meier analysis descriptively compared cause-specific survival.

Of 20,659 patients for whom the operation was recommended, 190 (0.9%) refused; of 11,745 for whom radiation was recommended, 478 (4.1%) refused. On multivariable analysis, refusal of the recommended operation was independently associated with older age (aOR: 16.08 for age ≥ 75 years, 95% CI: 6.26-41.33), Black race, single or divorced status, distant or unknown disease stage, and rural residence. Radiation refusal was associated with age ≥ 75 years (aOR: 2.28, 95% CI: 1.58-3.29), Asian/Pacific Islander race (aOR: 2.04, 95% CI: 1.52-2.73), and widowed or single status. Chemotherapy receipt was associated with lower odds of radiation refusal (aOR: 0.08, 95% CI: 0.04-0.16). Refusal of the recommended operation was associated with worse 5-year cause-specific survival (37.7% vs. 81.0%; p < 0.001). As a secondary analysis, radiation refusal was also associated with worse 5-year cause-specific survival (64.1% vs. 71.3%; p < 0.001).

Refusal of the recommended operation in salivary gland malignancies is uncommon (0.9%) but associated with markedly worse cause-specific survival. In a secondary analysis, radiation refusal (4.1%) was similarly associated with worse survival. Older age, race, marital status, disease stage, and rural residence were associated with refusal of the recommended operation; age, race, and marital status were key predictors of radiation refusal. These findings identify groups at higher risk of refusal who may benefit from early multidisciplinary input and patient navigation.

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