{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:40:18Z","timestamp":1761007218616,"version":"build-2065373602"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Major salivary gland cancers (MSGCs) are often treated with primary surgery followed by adjuvant therapy for high\u2010risk pathology. Patients with these cancers may opt out of recommended postoperative radiation therapy (PORT) for many reasons and consequently may suffer worse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>National Cancer Database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with MSGC from 2004 to 2016 were identified, and overall survival and risk factors for refusal of recommended PORT were analyzed based on demographic, socioeconomic, and clinical factors. Multivariable logistic regression and a Cox model were used to conduct the analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>211 out of 4704 qualifying patients (4.5%) refused recommended PORT. Multivariable analysis demonstrated increased PORT refusal for age &gt;74 years (odds ratio OR 4.34, confidence interval [CI] [2.43\u20107.85]), Asian race (OR 2.25, CI [1.10\u20104.23]), and certain facility types (comprehensive cancer center, OR 2.39, CI [1.08\u20106.34]; academic research program, OR 3.29, CI [1.49\u20108.74]; and integrated network cancer program, OR 2.75, CI [1.14\u20107.7]). N2 stage was associated with decreased PORT refusal (OR 0.67, CI [0.45\u20100.98]). The 5\u2010year overall survival for patients who received and refused PORT were significantly different at 65.8% and 53.8%, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). When controlling for several factors, PORT refusal was independently associated with significantly lower overall survival (HR 1.54, CI [1.21\u20101.98]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patient refusal of recommended PORT in MSGC is rare, associated with various disease and socioeconomic factors, and may decrease overall survival. Our findings can assist clinicians in counseling patients and identifying those who may be more likely to opt out of recommended PORT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.285","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T07:51:40Z","timestamp":1675756300000},"page":"577-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative Radiation Therapy Refusal in Major Salivary Gland Cancers"],"prefix":"10.1002","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3315-0665","authenticated-orcid":false,"given":"Keshav V.","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aman","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kush","family":"Panara","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven B.","family":"Cannady","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12105-017-0795-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819827851"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24984"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3342\/ceo.2010.3.2.96"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.03.024"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000681"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950160309"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/154411130301400306"},{"key":"e_1_2_8_10_1","first-page":"189","article-title":"Quality of life after salivary gland surgery","volume":"78","author":"Wax MK","year":"2016","journal-title":"Adv Otorhinolaryngol"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-4914-7"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.10.013"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29743"},{"key":"e_1_2_8_14_1","unstructured":"American College of Surgeons.National Cancer Database.facs.org.https:\/\/www.facs.org\/quality-programs\/cancer-programs\/national-cancer-database\/"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-009-0771-3"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.014"},{"key":"e_1_2_8_17_1","unstructured":"American College of Surgeons. National Cancer Data Base participant user file (PUF) data dictionary 2020;2020."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.19697"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22027"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26804"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2020.08.026"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/19345747.2011.618213"},{"key":"e_1_2_8_23_1","unstructured":"RiesLG YoungJ KeelG EisnerM LinY HornerM. SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program 1988\u20102001 Patient and Tumor Characteristics. National Cancer Institute SEER Program NIH Pub. No. 07\u20106215 Bethesda MD; 2007:193\u2010202."},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(07)70246-2"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25966"},{"key":"e_1_2_8_26_1","article-title":"Determinants of patient refusal of post\u2010operative radiation therapy in sinonasal squamous cell carcinoma","author":"Kshirsagar RS","year":"2022","journal-title":"J\u00a0Neurol\u00a0Surg\u00a0Part B"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.785602"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-021-01497-0"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7149.1970"},{"issue":"3","key":"e_1_2_8_30_1","first-page":"11","article-title":"Race, medicine, and health care in the United States: a historical survey","volume":"93","author":"Byrd WM","year":"2001","journal-title":"J Natl Med Assoc"},{"key":"e_1_2_8_31_1","unstructured":"Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In:SmedleyBD StithAY NelsonAR eds.2003."},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2013.0019"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10903-019-00936-z"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/19371910903240704"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0b013e3181d270ce"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.11.298"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.10.144"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.00449"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.158"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817717661"},{"key":"e_1_2_8_41_1","unstructured":"National Comprehensive Cancer Network. Head and neck cancers (version 2.2022);2022."},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181dbebe3"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.285","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.285","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:53:17Z","timestamp":1760961197000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,7]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1002\/ohn.285"],"URL":"https:\/\/doi.org\/10.1002\/ohn.285","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"type":"print","value":"0194-5998"},{"type":"electronic","value":"1097-6817"}],"subject":[],"published":{"date-parts":[[2023,2,7]]},"assertion":[{"value":"2022-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}