Factors Associated with Lung Cancer Patients Refusing Treatment and Their Survival: A National Cohort Study under a Universal Health Insurance in Taiwan

Abstract

BackgroundLung cancer is the leading cause mortality among all cancers in Taiwan. Although Taiwan offers National Health Insurance (NHI), occasionally, patients refuse treatment. This study examined the patient characteristics and factors associated with lung cancer patients refusing cancer treatment in four months after cancer diagnosed and compared the survival differences between treated and non-treated patients.MethodsThe study included 38584 newly diagnosed lung cancer patients between 2004 and 2008, collected from the Taiwan Cancer Registry, which was linked with NHI research database and Cause of Death data set. Logistic regression was conducted to analyze factors associated with treatment refusal. The Cox proportional hazards model was used to examine the effects of treatment and non-treatment on patient survival and the factors affecting non-treatment patient survival.ResultsAmong the newly diagnosed cancer patients, older adults, or those who had been diagnosed with other catastrophic illnesses, an increased pre-cancer Charlson Comorbidity Index (CCI) score, and advanced stage cancer exhibited an increased likelihood of refusing treatment. Compared with treated patients, non-treated patients showed an increased mortality risk of 2.09 folds. The 1-year survival rate of treated patients (53.32%) was greater than that of non-treated patients (21.44%). Among the non-treated patients, those who were older, resided in lowly urbanized areas, had other catastrophic illnesses, a CCI score of ≥4, advanced cancer, or had received a diagnosis from a private hospital exhibited an increased mortality risk.ConclusionsDespite Taiwan's NHI system, some lung cancer patients choose not to receive cancer treatment and the mortality rate for non-treated patients is significantly higher than that of patients who undergo treatment. Therefore, to increase the survival rate of cancer patients, treatment refusal should be addressed.

Colorectal cancer in Taiwan: A case‐control retrospective analysis of the impact of a case management programme on refusal and discontinuation of treatment

“…Older age (poor physical condition) and difficulty in enduring any condition likely to cause physical discomfort from the disease treatment were also reasons for refusing treatment. This is consistent with previous studies that found old age was a common reason for refusing treatment (Chen et al., ; Choi et al., ; Huang et al., ). More than one‐third of patients in the case group who refused treatment were more than 80 years of age and most were diagnosed with stage III or IV CRC.…”

“…This study of CRCs patients found that a total of 68 patients refused treatment. In our study, patients with CRC had a lower rate of refusal than those in previous studies (El Shayeb et al., ; Huang et al., ) and at the study institute prior to case management. This finding may be explained by the fact that over half of our study participants were at an early cancer stage at initial diagnosis than participants studied elsewhere.…”

“…() studied stage III CRCs patients, while nearly two‐third of patients included by Huang et al. () were at an advanced cancer stage. In both studies, key determinants in the decision‐making progress related to treatment were related to cancer stage and treatment modalities.…”

Risk factors associated with treatment refusal in lung cancer

“…Refusal of cancer treatment might result in rapid deterioration, emergence of physical symptoms, and metastasis. A study conducted in Taiwan showed that the mortality risk for lung cancer patients refusing treatment was elevated 2.1‐fold . Other studies of breast and colorectal cancer have consistently revealed that patients who delayed or refused therapy had lower five‐year survival rates compared to treated patients .…”

Factors involved in the delay of treatment initiation for cervical cancer patients

“…[4] Seeking a second opinion may also cause patients to delay treatment. [5] In Taiwan, a study by Huang et al [6] showed lung cancer patients who had higher treatment refusal rates were associated with factors such as men, older adults, high prediagnosis Charlson comorbidity index (CCI) score, other catastrophic illnesses or injury, and advanced cancer stage. The National Health Insurance (NHI) Program covers 99.9% of the population and waives copayments for patients with cancer.…”