Ethnic disparities in refusal to undergo survival-prolonging locoregional treatment (LT) indicated a need for reductions in barriers to care among some patient populations, according to results of a study published in JCO Oncology Practice.

Refusal of LT for prostate adenocarcinoma has been increasing over time. Patterns of refusal may be symptomatic of logistical difficulties to attend treatment sessions or deep-rooted mistrust of the healthcare system. To better understand the rise in treatment refusal, data from the Participant User File from the National Cancer Database from between 2004 and 2015 were retrospectively analyzed for clinical and sociodemographic covariates.

A total of 887,839 eligible patients were identified. These men were median age 64 years, 50.5% had intermediate risk disease, 82.1% were White, 13.6% were Black, 1.8% were Asian, and 0.2% were Native Americans.

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LT refusal occurred among 2487 (0.28%) patients.

Refusal was more frequent among men who had low-risk disease (0.49%; adjusted odds ratio [aOR], 0.34; 95% CI, 0.31-0.36; P <.001) compared with intermediate or high risk (0.20%). Black patients more frequently refused LT (0.42%; aOR, 1.46; 95% CI, 1.31-1.62; P <.001) compared with White patients (0.25%).

Stratified by risk group, men with intermediate or high risk who were Black (0.35%; aOR, 1.75; 95% CI, 1.52-2.01; P <.001) or Asian (0.29%; aOR, 1.47; 95% CI, 1.05-2.06; P =.027) were more likely to refuse LT compared with White patients (0.17%).

Refusing LT was associated with poorer 5-year overall survival (80.1% vs 91.5%; hazard ratio [HR], 1.65; P <.001).

This study was limited by not having access to specific motivations for refusing treatment.

These findings suggested that in general, men who had less advanced disease were more likely to refuse LT. There was a significant ethnicity interaction, in which fewer White patients refused treatment. Additional studies are needed to identify reasons for treatment hesitancy.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Dee EC, Arega MA, Yang DD, et al. Disparities in Refusal of Locoregional Treatment for Prostate Adenocarcinoma. JCO Oncol Pract. 2021;OP2000839. doi:10.1200/OP.20.00839