Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results

ObjectivesMost 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.MethodsBased 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).ResultsAmong 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, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); 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.ConclusionsPatient'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.

Quality of Life of Patients After Colorectal Cancer Surgery in Soba University Hospital, Sudan: A Cross-Sectional Study

Background: Colorectal surgery is reported to have significant effects on patients, both physically and psychologically. On other hand, infections are found to be a major risk factor in Sudan and Sub-Saharan Africa such as intestinal Schistosoma colitis, especially those presenting with sigmoid colonic adenocarcinoma.Aim of the study: To assess the quality of life of patients after colorectal cancer surgery and the effect of the stoma on their life.Methods: A descriptive cross-sectional hospital-based study was done at Soba University Hospital. A sample of 72 patients with colorectal cancer who had undergone colorectal surgery was fully covered and interviewed using the SF-36 Quality of life standard questionnaire.Results: The total sample was 72 with a mean age of 51.1 ± 14.6 years. 79% were married, 70% were working, with free business being the most encountered occupation (36.1%). However, only 48.6% were still employed at the time of surgery. Regarding the mental health component, there was a significant difference in social functioning domain mean scores between patients who were employed and unemployed patients. Where the physical functioning and role physical domains were found to differ significantly with the different educational attainment of patients. Patients who did not undergo radiation therapy reported higher mean scores of role limitation due to physical problems, compared to patients who received radiation therapy.Conclusion: Our result found the quality of life was affected negatively in terms of the level of pain and presence of colostomy with sexual activity affection but the other parameters were not strongly affected.

Effect of hemodialysis on short-term outcomes after colon cancer surgery

Background Hemodialysis patients who undergo surgery have a high risk of postoperative complications. The aim of this study was to determine whether colon cancer surgery can be safely performed in hemodialysis patients. Methods This multicenter retrospective study included 1372 patients who underwent elective curative resection surgery for colon cancer between April 2016 and March 2020. Results Of the total patients, 19 (1.4%) underwent hemodialysis, of whom 19 (100%) had poor performance status and 18 had comorbidities (94.7%). Minimally invasive surgery was performed in 78.9% of hemodialysis patients. The postoperative complication rate was significantly higher in hemodialysis than non-hemodialysis patients (36.8% vs. 15.5%, p = 0.009). All postoperative complications in the hemodialysis patients were infectious type. Multivariate analysis revealed a significant association of hemodialysis with complications (odds ratio, 2.9362; 95%CI, 1.1384–7.5730; p = 0.026). Conclusion Despite recent advances in perioperative management and minimally invasive surgery, it is necessary to be aware that short-term complications can still occur, especially infectious complications in hemodialysis patients.