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Breast Cancer Research and Treatment

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01-01-2021 | Breast Cancer | Epidemiology

Impact of patients’ refusal to undergo adjuvant treatment measures on survival

Authors: H. Männle, J. W. Siebers, F. Momm, K. Münstedt

Published in: Breast Cancer Research and Treatment | Issue 1/2021

Abstract

Purpose

Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients’ refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany.

Methods

A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan–Meier survival analyses, and Cox regression analyses regarding the effects of their refusal.

Results

About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ² = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ²_radiotherapy = 109.1; df = 1; p < 0.001, χ²_chemotherapy = 18.3; df = 1; p < 0.001, χ²_endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ²_radiotherapy = 184.9; df = 6; p < 0.001; χ²_chemotherapy = 191.8; df = 6; p < 0.001).

Conclusions

All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients’ refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.

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Title: Impact of patients’ refusal to undergo adjuvant treatment measures on survival
Authors: H. Männle
J. W. Siebers
F. Momm
K. Münstedt
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Radiotherapy
Cytostatic Therapy
Published in: Breast Cancer Research and Treatment / Issue 1/2021
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05939-1

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