Factors affecting treatment options in patients with advanced cancer of oral cavity-- A single institution prospective study from Southern India (#639)
Aim: Cancer of the oral cavity is one of the commonest cancers encountered in our patient population. Most of the patients present in advanced stage ignoring early symptoms,despite easy accessibility for examination and early symptoms.A significant number of these patients refuse further treatment after initial diagnosis and staging.This study aims to identify the reasons for Initial refusal of treatment.
Methods: This is a single institution prospective study conducted at Meenakshi Mission Hospital and Research Centre.All patients attending the oncologyoutpatient department between Jun - Dec 2011, with either T3/4 and /or N2c/3 oral cavity squamous cell carcinomas were included in this study. The basic demographic details and tumor details were collected.All patients who refused the treatment were given a semi structured questionnaire to fill in details for refusing treatment.The data were tabulated and analysed.
During the study period, 126 patients of advanced oral cavity cancers attended the OPD.Cancer of the tongue was the common subsite(50%) followed by buccal mucosa(15.8%),Alveolus(15.8%), Retromolar trigone(12.6%) and Hard palate(5.5%).
Of these, 70 patients(55.5%) refused further treatment.Not able to afford the treatment costs were the commonest reason given by over 50% of patients.Twenty five patients(35%) cited disfigurement as the reason for refusing radical surgery.Ten patients were of the opinion that cancer recurs faster after surgery and this misconception was the reason for refusal of treatment.Other factors cited were the self assessment by the patient and relatives that they were too weak and old to tolerate any major procedure.Overall , 48 patients(68.5%) cited a single factor as the reason for refusing treatment ,15 patients(21%) cited 2 factors and 7 patients cited more than 2 factors.After initial refusal, 34 of the 70 patients consented for further treatment, after active counselling by the treating physician.
Cost of the treatment is the major hindrance in the decision making of the patient and caregivers, in choosing optimal health care.Making health insurance mandatory and providing free insurance cover for the lower socioeconomic strata people will help them make early and wise decisions. Active counselling by the treating physicians is helpful in allaying the unfounded fears and misconceptions and help them in taking treatment decisions