Factors Related to Treatment Refusal in Taiwanese Cancer Patients


Background: Incidence and mortality rates for cancer have increased dramatically in the recent 30 years inTaiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and lifequality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusalof treatment in cancer patients via a cancer case manager system. Materials and
Methods: This study analyseddata from a case management system during the period from 2010 to 2012 at a medical center in NorthernTaiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model asa framework, we conducted logistic regression analysis to identify independent variables that are significantlyassociated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied toestimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI).
Results: A total of 253 patients(1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusalof treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001),changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which casemanager contact patients (p<0.001) and the frequency that case managers contact patients (≥10times) (p=0.016).
Conclusions: Cancer patients who refuse treatment have poor survival. The present study provides evidence offactors that are related to refusal of therapy and might be helpful for further application and improvement ofcancer care.