{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T02:11:26Z","timestamp":1782180686969,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,8,2]],"date-time":"2018-08-02T00:00:00Z","timestamp":1533168000000},"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":["The Laryngoscope"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To investigate the risk factors for refusal of recommended surgery in head and neck squamous cell carcinoma (HNSCC) treatment<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective review of a national database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Surveillance, Epidemiology, and End Results database was queried for all cases of HNSCC from 1989 to 2014. Patients who underwent recommended surgery (N\u2009=\u200998,270) were identified and compared to patients who refused recommended surgery (N\u2009=\u20093,582). Groups were compared for patient demographics, socioeconomic variables, and tumor characteristics including stage, grade, and primary site. Binary logistic regression was performed to determine independent predictors of surgery refusal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the total population, 1.8% of patients refused cancer directed surgery. Following regression, the strongest predictors of surgery refusal were found to be age greater than 75years (odds ratio [OR]: 4.23 [95% confidence interval {CI}: 3.00\u20105.96]), and stage III (OR: 4.19 [95% CI: 3.15\u20105.57]) or stage IV at diagnosis (OR: 4.49 [95% CI: 3.46\u20105.80]). Black race was significantly predictive (OR: 1.71 [95% CI: 1.37\u20102.13]) as well as marital status other than married (OR: 1.76 [95% CI: 1.49\u20102.07]) and Medicaid insurance status (OR:1.46 [95% CI: 1.20\u20101.77]). Primary site of larynx (OR: 2.01 [95% CI: 1.71\u20102.37]) or base of tongue (OR: 2.34 [95% CI: 1.87\u20102.92]) additionally predicted surgery refusal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A number of demographic, socioeconomic, and tumor\u2010related variables are associated with refusal of cancer\u2010directed surgery in head and neck squamous cell carcinoma. Recognition of these factors may help identify situations where more active education and support are needed to help patients accept optimal care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<\/jats:p><jats:p><jats:italic>Laryngoscope<\/jats:italic>, 129:1368\u20131373, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27116","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T03:19:21Z","timestamp":1533611961000},"page":"1368-1373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Refusal of Cancer\u2010Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-2552","authenticated-orcid":false,"given":"Meghan M.","family":"Crippen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus L.","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Weisberger","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0223-1518","authenticated-orcid":false,"given":"Jacob S.","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Anderson","family":"Eloy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."},{"name":"Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey Rutgers New Jersey Medical School Newark New Jersey U.S.A."},{"name":"Department of Neurological Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soly","family":"Baredes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A."},{"name":"Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey Rutgers New Jersey Medical School Newark New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5780-5227","authenticated-orcid":false,"given":"Richard Chan Woo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey 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