Refusal of adjuvant therapy linked to worse oral cancer outcomes
Click Here to Manage Email Alerts
Key takeaways:
- Patients who refused adjuvant therapy for oral cancer had markedly worse OS and RFS.
- Study findings should help clinicians guide patients considering refusal of adjuvant therapy.
Individuals with advanced squamous cell carcinoma who refused adjuvant therapy had worse oncologic outcomes, according to data published in JAMA Otolaryngology Head & Neck Surgery.
Disease recurrence during follow-up is estimated to be 34% higher among patients who refuse adjuvant therapy compared with patients who completed it, researchers noted.
“We suggest that the data from this study might help to guide decision-making in evaluating the advantages and disadvantages of [adjuvant therapy],” Friedrich Mrosk, MD, a member of the department of oral and maxillofacial surgery at Charité–Universitätsmedizin Berlin, and colleagues wrote. “Previous studies reported low socioeconomic status, increased age, distance to treatment facility, and female sex as risk factors for refusal.”
Background and methodology
Despite recommendations that it improves OS, some patients may refuse recommended adjuvant therapy following primary resection of an advanced oral squamous cell carcinoma. Limited research data exist on the oncologic outcomes and associated factors after refusal of adjuvant therapy among this patient group, researchers explained as part of the study’s background information.
Mrosk and colleagues conducted a single-center matched cohort study to evaluate the difference in survival and disease recurrence for patients with and without recommended adjuvant therapy following resection of advanced oral squamous cell carcinoma.
The retrospective analysis included 82 adults with advanced oral squamous cell carcinoma (mean age at time of surgery, 68 years; 46.3% women) with a 1:1 ratio of those who refused or completed recommended adjuvant therapy between 2010 and 2021.
The comparison of OS and RFS between the two study groups served as dual primary outcomes.
Median follow-up was 25 months (interquartile range, 14.8-36.0) months.
Results, next steps
Patients who refused adjuvant therapy developed more frequent disease recurrence than patients who completed adjuvant therapy (61% vs. 26.8%; difference = 34.2%; OR = 4.26, 95% CI, 1.68-10.84).
Additionally, patients who refused adjuvant therapy exhibited lower 2-year OS rates (72.7% vs. 88.6%; difference = 15.9%; 95% CI, 8.6-40.6) and lower 2-year RFS rates (39.1% vs. 74.2%; difference = 35.1%; 95% CI, 0.2-70.5).
Among patients who rejected adjuvant therapy, results showed worse OS associated with female sex (48.6% vs. 90.5%; difference = 41.9%; 95% CI, 0.6-84.4), pT1-2 tumor category (57.1% vs. 92.3%; difference = 35.2%; 95% CI, 3.3-73.6), and pN1 or higher tumor category (61.2% vs. 82.6%; difference = 21.4%; 95% CI, 14.1-56.8).
Investigators observed associations between lower RFS and female sex (37.9% vs. 90.9%; difference = 53%; 95% CI, 8-97.9), advanced tumor category (pT3-4, 35.3% vs. 80%; difference = 44.7%; 95% CI, 6.4-95.3), lymph node yield of 20 or greater (31.4% vs. 80.6%; difference = 49.2%; 95% CI, 4.9-93.4), and lymph node ratio of less than 4.6% (36.6% vs. 84.4%; difference = 47.8%; 95%CI, 1.8-93.1).
The researchers acknowledged the small sample size as a potential study limitation but maintained that the results could help guide clinical decision-making because of the scarcity of data available on the refusal of adjuvant therapy among this specific patient population.
“In this matched cohort study, refusal of [adjuvant therapy] was associated with poor oncological outcomes of lower RFS and OS,” researchers wrote. “The results of this study may guide physicians and patients who are confronted with the consideration of refusal or withdrawal in regard to their oncological outcome.”
Collapse
Click Here to Manage Email Alerts