{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:02:48Z","timestamp":1793070168595,"version":"4.5.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Most non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial\/ethnic disparities in surgery refusal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Based on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial\/ethnic categories were included: White, black, Hispanic, and Asian\/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured\/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11\u20131.26; API-white: adjusted OR, 1.56; 95% CI, 1.41\u20131.72); those racial\/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung\/bronchus, liver, and stomach cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial\/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2021.785602","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T06:09:12Z","timestamp":1642399752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results"],"prefix":"10.3389","volume":"9","author":[{"given":"Xianglin","family":"Hu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangjun","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangbai","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1245\/s10434-020-08783-1","article-title":"Refusal of cancer-directed surgery in patients with colon cancer: risk factors of refusal and survival data","volume":"28","author":"Makar","year":"2021","journal-title":"Ann Surg Oncol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3427","DOI":"10.1245\/s10434-018-6680-6","article-title":"Race and health disparities in patient refusal of surgery for early-stage pancreatic cancer: an NCDB cohort study","volume":"25","author":"Tohme","year":"2018","journal-title":"Ann Surg Oncol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1007\/s10552-019-01240-9","article-title":"Disparities in surgery for early-stage cancer: the impact of refusal","volume":"30","author":"Rapp","year":"2019","journal-title":"Cancer Causes Control."},{"key":"B4","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1001\/jamaoncol.2019.5672","article-title":"Association of insurance status and racial disparities with the detection of early-stage breast cancer","volume":"6","author":"Ko","year":"2020","journal-title":"JAMA Oncol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1007\/s12020-020-02301-9","article-title":"The impact of surgery refusal on thyroid cancer survival: a SEER-based analysis","volume":"70","author":"van Gerwen","year":"2020","journal-title":"Endocrine."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3439","DOI":"10.1200\/JCO.20.00642","article-title":"Cancer disparities and health equity: a policy statement from the American Society of Clinical Oncology","volume":"38","author":"Patel","year":"2020","journal-title":"J Clin Oncol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1097\/SLA.0000000000004653","article-title":"The impact of racial residential segregation on colorectal cancer outcomes and treatment","volume":"273","author":"Poulson","year":"2021","journal-title":"Ann Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/SLA.0000000000004451","article-title":"Residential racial segregation and disparities in breast cancer presentation, treatment, and survival","volume":"273","author":"Poulson","year":"2021","journal-title":"Ann Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1016\/j.amjsurg.2020.04.022","article-title":"Refusal of cancer-directed treatment by colon cancer patients: risk factors and survival outcomes","volume":"220","author":"Kaltenmeier","year":"2020","journal-title":"Am J Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.amjsurg.2020.06.020","article-title":"Refusal of surgery for colon cancer: sociodemographic disparities and survival implications among US patients with resectable disease","volume":"221","author":"Alty","year":"2021","journal-title":"Am J Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1002\/jso.25917","article-title":"Sociodemographic predictors of surgery refusal in patients with stage I-III colon cancer","volume":"121","author":"Lu","year":"2020","journal-title":"J Surg Oncol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"829439","DOI":"10.1155\/2015\/829439","article-title":"Prostate cancer patients' refusal of cancer-directed surgery: a statewide analysis","volume":"2015","author":"Islam","year":"2015","journal-title":"Prostate Cancer."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e1489","DOI":"10.1200\/OP.20.00839","article-title":"Disparities in refusal of locoregional treatment for prostate adenocarcinoma","volume":"17","author":"Dee","year":"2021","journal-title":"JCO Oncol Pract."},{"key":"B14","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1245\/s10434-011-2087-3","article-title":"Race and health disparities in patient refusal of surgery for early-stage non-small cell lung cancer: a SEER cohort study","volume":"19","author":"Mehta","year":"2012","journal-title":"Ann Surg Oncol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/1759-7714.12461","article-title":"Risk factors associated with treatment refusal in lung cancer","volume":"8","author":"Suh","year":"2017","journal-title":"Thorac Cancer."},{"key":"B16","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.ccm.2020.02.001","article-title":"Alternatives to surgery for early-stage non-small cell lung cancer: stereotactic radiotherapy","volume":"41","author":"Beaty","year":"2020","journal-title":"Clin Chest Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.jss.2019.04.083","article-title":"Stereotactic body radiotherapy versus surgery for early-stage non-small-cell lung cancer","volume":"243","author":"Li","year":"2019","journal-title":"J Surg Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1007\/s11605-020-04885-z","article-title":"Refusal of surgery among patients with early-stage hepato-pancreato-biliary cancers: predictive factors and outcomes","volume":"25","author":"Mirdad","year":"2021","journal-title":"J Gastrointest Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1245\/s10434-018-6708-y","article-title":"Correlates of refusal of surgery in the treatment of non-metastatic pancreatic adenocarcinoma","volume":"26","author":"Coffman","year":"2019","journal-title":"Ann Surg Oncol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.sopen.2020.07.001","article-title":"Refusal of colorectal cancer surgery in the United States: predictors and associated cancer-specific mortality in a surveillance, epidemiology, and end results (SEER) cohort","volume":"2","author":"Delisle","year":"2020","journal-title":"Surg Open Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"4941","DOI":"10.21873\/anticanres.13682","article-title":"Characteristics of breast cancer patients who refuse surgery","volume":"39","author":"Restrepo","year":"2019","journal-title":"Anticancer Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e469","DOI":"10.1016\/j.clbc.2017.07.010","article-title":"Refusal of cancer-directed surgery by breast cancer patients: risk factors and survival outcomes","volume":"18","author":"Gaitanidis","year":"2018","journal-title":"Clin Breast Cancer."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1177\/00031348211024170","article-title":"Patients with invasive breast cancer who refuse treatment: an analysis of associated factors and impact on survival","volume":"87","author":"Moya","year":"2021","journal-title":"Am Surg."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.785602\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T06:09:16Z","timestamp":1642399756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.785602\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,17]]},"references-count":23,"alternative-id":["10.3389\/fpubh.2021.785602"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.785602","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,17]]},"article-number":"785602"}}