Refusal of Cancer-Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

Meghan M. Crippen, Marcus L. Elias, Joseph S. Weisberger, Jacob S. Brady, Jean Eloy, Soly Baredes, Richard Chan Woo Park

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objectives/Hypothesis: To investigate the risk factors for refusal of recommended surgery in head and neck squamous cell carcinoma (HNSCC) treatment. Study Design: Retrospective review of a national database. Methods: The Surveillance, Epidemiology, and End Results database was queried for all cases of HNSCC from 1989 to 2014. Patients who underwent recommended surgery (N = 98,270) were identified and compared to patients who refused recommended surgery (N = 3,582). 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. Results: 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}: 3.00-5.96]), and stage III (OR: 4.19 [95% CI: 3.15-5.57]) or stage IV at diagnosis (OR: 4.49 [95% CI: 3.46-5.80]). Black race was significantly predictive (OR: 1.71 [95% CI: 1.37-2.13]) as well as marital status other than married (OR: 1.76 [95% CI: 1.49-2.07]) and Medicaid insurance status (OR:1.46 [95% CI: 1.20-1.77]). Primary site of larynx (OR: 2.01 [95% CI: 1.71-2.37]) or base of tongue (OR: 2.34 [95% CI: 1.87-2.92]) additionally predicted surgery refusal. Conclusions: A number of demographic, socioeconomic, and tumor-related variables are associated with refusal of cancer-directed 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. Level of Evidence: 4. Laryngoscope, 129:1368–1373, 2019.

Original languageEnglish (US)
Pages (from-to)1368-1373
Number of pages6
Issue number6
StatePublished - Jun 1 2019

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology


  • Epidemiology
  • Head and neck cancer
  • Surveillance
  • and End Results database
  • refusal of surgery
  • squamous cell carcinoma
  • surgery

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