Key result
Refusing surgery for nonmetastatic colorectal cancer significantly increased cancer-specific mortality by more than 5-fold compared to undergoing surgery.
Why the study?
To understand patient factors associated with refusal of surgery for nonmetastatic colorectal cancer and its associated cancer-specific mortality.
Does refusal of surgery increase cancer-specific mortality in patients with nonmetastatic colorectal cancer?
Cohort (n=153,698)
Yes
Does refusal of surgery increase cancer-specific mortality in patients with nonmetastatic colorectal cancer?
Hazard Ratio: 5.1 (95% CI 4.62–5.62)
p-value: p=<0.01
Refusal of surgery for nonmetastatic colorectal cancer is associated with a five-fold increase in cancer-specific mortality.
Patients declining surgery warrant intensified counseling; this cohort association extends prior data but leaves causal effects and interventions open.
INTRODUCTION: This study aims to understand patient factors associated with refusal of surgery for nonmetastatic colorectal cancer and the associated cancer-specific mortality. METHODS: Patients diagnosed with nonmetastatic colorectal cancer between 2004 and 2015 from the Surveillance, Epidemiology, and End Results Program were included. RESULTS: A total of 152,731 (99.4%) patients underwent surgery, and 983 (0.6%) refused surgery. Independent predictors of refusal included male sex, older age, minority race, single relationship status, being uninsured, more recent date of diagnosis, having an earlier stage of diagnosis, and rectal versus colon cancer. Refusing surgery for nonmetastatic colorectal cancer increased cancer-specific mortality (adjusted hazard ratio 5.10, 95% confidence interval 4.62-5.62). CONCLUSION: Most patients diagnosed with nonmetastatic colorectal cancer undergo surgery in the United States. However, refusal of surgery is increasing and associated with higher cancer-specific mortality. A better understanding of surgical decision making in colorectal cancer is urgently needed.
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Delisle et al. (2020) conducted a cohort in Nonmetastatic primary colorectal adenocarcinoma (n=153,698). Refusal of surgery vs. Undergoing surgery was evaluated on Cancer-specific mortality (HR 5.10, 95% CI 4.62-5.62, p=<0.01). Refusing surgery for nonmetastatic colorectal cancer significantly increased cancer-specific mortality by more than 5-fold compared to undergoing surgery.
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