WCLC 2025 - Posters & ePosters-EP.13.39 Factors Associated With Refusal of Chemoradiotherapy in Stage I-III Small Cell Lung Cancer and Their Effect on Survival

EP.13.39 Factors Associated With Refusal of Chemoradiotherapy in Stage I-III Small Cell Lung Cancer and Their Effect on Survival

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This study investigated factors influencing refusal of chemoradiotherapy and its impact on overall survival (OS) in patients with stage I-III small-cell lung cancer (SCLC) using the National Cancer Database from 2004-2019. Among 68,764 patients recommended for chemoradiotherapy, 1,493 (2.2%) refused treatment. Multivariate logistic regression identified several factors linked to higher refusal rates: age over 50 (OR 2.43), female sex (OR 1.19), higher Charlson-Deyo comorbidity scores (CDCS 1: OR 1.38, CDCS 2: OR 1.89), Medicare insurance (OR 1.81), treatment facility located in the Western US (OR 1.47), larger tumor sizes (2-4cm OR 1.28; >4cm OR 1.40), acceptance of palliative care (OR 1.41), and refusal of surgery (OR 93.84). Private insurance was associated with reduced refusal odds (OR 0.52).<br /><br />Using propensity score matching, Kaplan-Meier and Log-Rank analyses demonstrated that chemoradiotherapy refusal significantly reduced median OS across all stages: Stage I (36.7 vs. 11.7 months, HR 3.67), Stage II (22.9 vs. 6.9 months, HR 2.89), and Stage III (17.1 vs. 3.4 months, HR 5.65), all with p<0.01.<br /><br />Among patients who refused chemoradiotherapy, factors linked to decreased survival included higher comorbidity scores (CDCS 1: HR 1.18; CDCS 2: HR 1.49), treatment in Southern (HR 1.20) and Midwestern states (HR 1.31), care at non-academic centers (HR 1.01), stage III disease (HR 1.94), larger tumors (>4cm, HR 1.60), and surgery refusal (HR 2.73). Conversely, Non-Hispanic Black race (HR 0.57) and moderate median income ($50,354-$63,332; HR 0.84) were associated with improved survival.<br /><br />In conclusion, chemoradiotherapy significantly improves survival in stage I-III SCLC. Identifying and addressing factors contributing to refusal, such as insurance status, comorbidities, and demographics, through targeted counseling and interventions could enhance treatment acceptance and improve patient outcomes.

Asset Subtitle

Yagni Patel

Meta Tag

Speaker Yagni Patel

Topic Small Cell Lung Cancer and Neuroendocrine Tumors

Keywords

small-cell lung cancer

chemoradiotherapy refusal

overall survival

National Cancer Database

comorbidity scores

insurance status

tumor size

palliative care

propensity score matching

treatment facility location