Untreated oral cavity cancer: Long-term survival and factors associated with treatment refusal.

OBJECTIVE

Oral cavity cancer is the most common malignant disease of the head and neck. The natural course of the disease is poorly characterized and unavailable for patient consideration during initial treatment planning. Our primary objective was to outline this natural history, with a secondary aim of identifying predictors of treatment refusal.

STUDY

DESIGN

Retrospective review of adult patients with oral cavity cancer who refused surgery that was recommended by their physician in the National Cancer Database.

METHODS

Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.

RESULTS

Patients who were older, uninsured, had government insurance, or had more advanced disease were more likely to go untreated. Survival among untreated patients was poor, but there was a small proportion of patients surviving long term. Five-year survival rates ranged from 31.1% among early-stage patients to 12.6% among stage 4 patients.

CONCLUSION

Although the natural course of oral cavity cancer carries a poor prognosis, there are a number of patients with longer-than-expected survival. The survival estimates may provide supplemental information for patients deciding whether to pursue treatment. In addition to age and extent of disease, system factors such as insurance status and facility case volume are associated with a patient's likelihood of refusing treatment.

LEVEL OF EVIDENCE: 4. Laryngoscope, 128:664-669, 2018.