Refusal of cancer therapy in testicular cancer: Recognizing and preventing a significant problem
Of 244 patients with testicular cancer who were treated at our medical center between 1970 and 1987, 7 (2.9%) refused all or a portion of their cancer therapy. All refusers died of cancer, and 6 of the 7 deaths were directly attributable to the refusal. Refusers were compared with the remaining patients; whereas there was no significant difference in age, race, and pathology of the tumor between the two groups, the more advanced initial stage of disease in the refusers approached significance (P=0.073), and the history of untreated cryptorchidism was more prevalent in that group (P=0.034). Combination chemotherapy was the treatment modality most often refused; however, refusal was not simply due to chemotherapeutic side effects but was a multifactorial problem. Characteristics common in the refusers included lower educational and employment status, higher religiosity, a more dependent personality and life-style, as well as other character deficits. In the current era of high cure rates in testicular cancer patients, refusal and refusal deaths are highly clinically significant and efforts to identify likely refusers and thus avert refusal episodes are necessary. © 1990 Springer-Verlag.
Moul, JW; Paulson, DF; Walther, PJ
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