Cancer Patients Who Refuse Treatment

The value of cancer treatment was assessed using a 'natural experiment' where patients who refused treatment served as no-treatment controls in a situation where withholding treatment to form a control group is unethical. Each cancer patient who refused treatment in Alberta, Canada between...

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Bibliographic Details
Published in:Cancer causes & control 1993-05, Vol.4 (3), p.179-185
Main Authors: Huchcroft, Shirley A., Snodgrass, Tomas
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Bioethics
Cancer
Case-Control Studies
Child
Child, Preschool
Control Groups
Death
Denial
Epidemiology
Female
Health care industry
Humans
Infant
Infant, Newborn
Lung neoplasms
Lungs
Male
Middle Aged
Neoplasm Staging
Neoplasms - mortality
Neoplasms - pathology
Neoplasms - therapy
Occupations
Predictive Value of Tests
Proportional Hazards Models
Prostate
Rectum
Registries
Research Papers
Survival Rate
Treatment Outcome
Treatment Refusal
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Summary:The value of cancer treatment was assessed using a 'natural experiment' where patients who refused treatment served as no-treatment controls in a situation where withholding treatment to form a control group is unethical. Each cancer patient who refused treatment in Alberta, Canada between 1975 and 1988 was compared with five subjects who accepted treatment, matched on cancer site, age, number of cancers, and time period. Variables associated with treatment-refusal were included in Cox's proportional hazards model of survival, with death from cancer as the endpoint and deaths from other causes as censored observations. Treatment was refused at a rate of 7.5 per 1,000. One-third of patients who refused treatment had lung cancer and most had unstaged disease. Treatment refusal was associated with a difference in median survival of approximately nine months. Site-specific analyses showed a range of effects. Case fatality among the treated patients fell by approximately 10 percent during the 14-year study period. Even in advanced disease, treatment can result in improved survival. However, the results of this study must be interpreted with caution and cannot be generalized to all cancer patients.
ISSN:0957-5243
1573-7225
DOI:10.1007/BF00051311