Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease

Background: We aimed to identify factors associated with refusal of surgery among patients with colon cancer. Methods: This 2004-2016 NCDB retrospective study identified AJCC stage I-Ill colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders. Results: Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival. Conclusions: Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making. (C) 2020 Elsevier Inc. All rights reserved.