(0221) Factors Predicting Surgical Treatment Refusal in Head and Neck Cancer Patients

Introduction: Surgical resection is a cornerstone of treatment in patients diagnosed with head and neck cancer (HNC). However, treatment is often accompanied by significant functional morbidities and economical burden ultimately leading to some patients declining treatment. Goal of this study was to investigate the role of social determinants of health in refusal of surgical treatments in HNC patients.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to examine patients with a documented diagnosis of HNC and their cause of death from 2000 to 2020. Social Vulnerability Index (SVI) was used to capture the social determinants of health amongst patients. Patients with unknown treatment status were excluded from analysis.

Results: In total, 110,290 patients with HNC and documentation of treatment plans were identified. Patients were categorized into whether they underwent surgery or refused surgical treatment. Patients were stratified into 4 quartiles based on their respective SVI, with Q1 being least socially vulnerable and Q4 being the most vulnerable. In multivariable Cox regression analysis, patients living in more disadvantaged counties (ref = Q1), older (ref = 0-49 years old), Black and Asian race (ref = White), and single marital status (ref = married) were more likely to refuse surgical treatment.

Conclusions: The preliminary results of our study identify significant predictors of surgical treatment refusal in HNC patients. We report interesting association between higher SVI scores and increased likelihood of refusing surgical treatment. Our findings shed light on the role that different social determinants of health such as socioeconomic status and education can play in patients’ decision making, potentially leading to adverse outcomes.