Factors predicting for patient refusal of head and neck cancer therapy

Background: The purpose of this study was to evaluate the national rate of treatment refusal in head and neck cancer (HNC). Methods: The National Cancer Database was queried for nonmetastatic squamous cell carcinoma of the head and neck. Oncologic therapy referred to receipt of surgery, radiotherapy, or chemotherapy. Results: Compared to the 230 424 patients who received treatment, 2965 (1.3%) were reported to have refused definitive therapy. Predictors included older age, female sex, African-American/other race, nonprivate insurance, greater comorbidities, more advanced disease, and residence closer to the treating facility (P <.05). Patients with a prior history of cancer, Hispanic race, those treated at academic centers, and those from higher income counties were less likely to refuse therapy (P <.05). Patients who refused definitive therapy experienced poorer survival (median 79.1 vs 8.7 months, P <.001). Conclusions: Refusing oncologic therapy is relatively rare in HNC and appears to be multifocal in nature.