Abstract P6-08-19: Outcomes of patients with invasive breast cancer (IBC) refusing standard cancer treatments: 10-year analysis of the National cancer data base (NCDB)
Authors: Orucevic A , Heidel RE , Bell JL 
Published: February 2018

Abstract
Breast cancer treatments (Rx) are becoming more individualized; however, there remain patients (pts) who refuse recommended standard Rx. There is paucity of data defining the characteristics of these pts. Our study objective was to identify socioeconomic characteristics of pts who refuse recommended Rx and analyze their outcome.
Female pts diagnosed with IBC from 2004-2014 were selected from the NCDB. Socioeconomic characteristics and overall survival (OS) of pts who refused standard Rx (surgery, chemotherapy, anti-estrogen therapy, or radiation) were compared with an exact number of randomly matched patients who received recommended Rx. Frequency statistics, Mann-Whitney U test and logistic regression were used in statistical analyses.
There were 1772260 IBC pts; 11164 (0.6%) refused surgery; 108,486 (6.1%) refused chemotherapy; 68,995 (3.9%) refused anti-estrogen; 52,081 (2.9%) refused radiation. Pts who refused recommended Rx were significantly more likely to die, to be older, non-Caucasian race, lower income, and surprisingly higher education than pts who received recommended Rx (p&lt;0.05).
Results reveal that older age, non-Caucasian race, and lower income were correlated with refusal of recommended Rx for IBC and consequently significantly worse OS compared to matched pts that received recommended Rx. When putting this into national perspective, this data reveals that almost 10% (˜25,000/yr) of newly diagnosed pts with IBC may choose to refuse one or more of recommended standard Rx. Further study is necessary to identify reasons for refusal and ways to minimize these events.
Surgery NOSurgery YESChemoRx NOChemoRx YESAnti-estrogen Rx NO†Anti-estrogen Rx YES†# pts11164Random 11164 / 1630429108486Random 108486 /73550168995Random 68995 / 1039320N %OSDead6004 60.91639 16.320339 21.717159 17.512445 20.58726 14.2Alive3855 398393 83.773362 78.380710 82.548254 79.552534 85.8Odds ratio for death (95%CI)7.9 (7.4-8.5)*1.3 (1.2-1.3)*1.5 (1.5-1.6)*Survival months (mean)60.87452.86053.359.1Age≤40225 2727 6.52602 2.411911 113210 4.73583 5.241-693507 31.4*7330 65.760764 56*84835 78.236477 52.9**46575 67.570+7432 66.6*3107 27.845120 41.6*11740 10.829308 42.5**18837 27.3RaceWhite8439 75.69414 84.392013 84.887256 80.459542 86.359448 86.2Black2162 19.4*1215 10.911190 10.3**15188 146408 9.3 NS6259 9.1Other408 3.7*423 3.84323 4**4953 4.62369 3.4**2639 3.8Unknown155 1.4112 1960 0.91089 1676 1649 0.9Income≤38K2239 20.31652 14.916393 15.217146 169282 13.69645 14.138K-479992580 23.4**2359 21.324195 22.5*23071 21.514594 21.3*14473 21.248K-629992845 25.8**2991 2729646 27.5*28524 26.619335 28.2*18504 2763K+3378 30.6**4067 36.737489 34.8 NS38678 3625282 36.9 NS25798 37.7% with NO high school diploma21+1834 16.61578 14.314619 13.617427 16.2809111.89354 13.713-20.92937 26.62668 24.126426 24.5*26095 24.315697 22.9*15756 237-12.93686 33.4**3695 33.437084 34.4*35198 32.823997 35*23260 34&lt;72588 23.4**3131 28.329641 27.5*28738 26.720728 30.3*20080 29.3p&lt;.05 *higher or **lower likelihood to refuse Rx (logistic regression, 1st category=referent) NS=Not significant; †Radiation Rx data not shown, similar trends to anti-estrogen Rx
Citation Format: Orucevic A, Heidel RE, Bell JL. Outcomes of patients with invasive breast cancer (IBC) refusing standard cancer treatments: 10-year analysis of the National cancer data base (NCDB) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-19.