{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T12:40:57Z","timestamp":1782650457354,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T00:00:00Z","timestamp":1570147200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The purpose of this study was to evaluate the national rate of treatment refusal in head and neck cancer (HNC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The National Cancer Database was queried for nonmetastatic squamous cell carcinoma of the head and neck. Oncologic therapy referred to receipt of surgery, radiotherapy, or chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to the 230\u2009424 patients who received treatment, 2965 (1.3%) were reported to have refused definitive therapy. Predictors included older age, female sex, African\u2010American\/other race, nonprivate insurance, greater comorbidities, more advanced disease, and residence closer to the treating facility (<jats:italic>P<\/jats:italic> &lt;\u2009.05). Patients with a prior history of cancer, Hispanic race, those treated at academic centers, and those from higher income counties were less likely to refuse therapy (<jats:italic>P<\/jats:italic> &lt;\u2009.05). Patients who refused definitive therapy experienced poorer survival (median 79.1 vs 8.7 months, <jats:italic>P<\/jats:italic> &lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Refusing oncologic therapy is relatively rare in HNC and appears to be multifocal in nature.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.25966","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T13:45:41Z","timestamp":1570196741000},"page":"33-42","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Factors predicting for patient refusal of head and neck cancer therapy"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6205-5969","authenticated-orcid":false,"given":"Arya","family":"Amini","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-6023","authenticated-orcid":false,"given":"Vivek","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Allegheny General Hospital  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayana","family":"Vora","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Gernon","sequence":"additional","affiliation":[{"name":"Department of Surgery City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pathology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Karam","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Colorado School of Medicine  Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erminia","family":"Massarelli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellie G.","family":"Maghami","sequence":"additional","affiliation":[{"name":"Department of Surgery City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Glaser","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology City of Hope National Medical Center  Duarte California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301213280306"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31815ae3d2"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20963"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.017863"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjom.2000.0547"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0b013e3181d270ce"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7819-10-118"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.03.024"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.10.013"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1523-3"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-007-9747-3"},{"key":"e_1_2_7_13_1","unstructured":"National Comprehensive Cancer Network. 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