Why Do Some People Refuse Chemotherapy for Advanced-Stage Breast Cancer?

Why Do Some People Refuse Chemotherapy for Advanced-Stage Breast Cancer?

People’s age, the type of health insurance they had, where they lived, and the number of other health conditions they had were all factors in their refusal to receive chemotherapy to treat advanced-stage breast cancer.
Sep 22, 2022.
 

New research has found that people diagnosed with stage III or stage IV breast cancer refused to receive chemotherapy based on several factors, including:

  • the geographic region where they lived

  • their age

  • the type of health insurance they had

  • the number of other health conditions they had

The research was published in the Sept. 1, 2022, issue of JCO Oncology Practice. Read the abstract of “Geographical Disparities and Factors Associated With the Decision to Decline Chemotherapy in Breast Cancer.”

 

About the study

After you’ve been diagnosed with breast cancer, you and your doctor develop a treatment plan based on a number of factors, including the characteristics of the cancer, your health history, and your personal preferences.

Some people decide to refuse certain treatments even though the treatments are recommended by their doctor. In this study, the researchers looked at the factors that influenced people’s decisions about whether or not to have chemotherapy to treat stage III or stage IV breast cancer.

The researchers looked at the records of 215,284 people diagnosed with stage III or stage IV breast cancer between 2004 and 2017. The information came from the National Cancer Database, a national registry that includes data from more than 1,500 medical institutions in the United States.

The doctors recommended chemotherapy for all the people in the study.

The researchers’ analysis showed that several factors were linked to people refusing chemotherapy:

  • People who lived in the New England area — Connecticut, Massachusetts, Maine, New Hampshire, and Vermont — were the most likely to refuse chemotherapy versus people who lived in other areas of the country.

  • People who were older than 70 were more likely than younger people to refuse chemotherapy.

  • People who had no health insurance were more likely to refuse chemotherapy than people who had private insurance, Medicare, or Medicaid.

  • People who were receiving treatment at a community cancer center were more likely to refuse chemotherapy than people receiving treatment at an academic institution.

  • People who had two or three other health conditions were more likely to refuse chemotherapy than people who had no other health conditions.

  • People diagnosed with hormone receptor-positive, HER2-positive breast cancer were the most likely to refuse chemotherapy versus people diagnosed with other types of breast cancer.

  • The rate of refusing chemotherapy among people diagnosed with stage IV breast cancer gradually increased from 2004 to 2014 and then dropped sharply from 2014 to 2017.

  • The rate of refusing chemotherapy among people diagnosed with stage III breast cancer gradually increased from 2004 to 2017.

“Cancer treatment adherence or refusal is a complicated phenomenon that includes several factors, including an association with a patient’s geographic location, as this study suggests,” the researchers wrote. “Understanding the complexity of patient decision making is vital to successfully delivering cancer treatment. Understanding the many factors influencing treatment decisions and improving physician-patient communication could improve outcomes.”

 

What this means for you

Chemotherapy is commonly recommended as a treatment for stage III or stage IV breast cancer, often in combination with other medicines, such as targeted therapy or immunotherapy.

Nearly all chemotherapy medicines cause side effects, some of them severe. You and your doctor weigh the benefits against the side effects when deciding which chemotherapy regimen is best for you.

If your doctor recommends chemotherapy for you and you decide not to receive it, it’s important to know that you’re probably not receiving the standard of care for the type of breast cancer you’ve been diagnosed with.

Still, final treatment decisions are your choice. If you’re unclear about how chemotherapy can help your unique situation, it’s a good idea to ask your doctor to explain the benefits and side effects again so you can make the most informed decision possible.

Learn more about Chemotherapy.

Written by: Jamie DePolo, senior editor

— Last updated on September 23, 2022, 6:27 PM

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