title: Who does not receive treatment for cancer?
abstract: OBJECTIVE
  Little has been published on nontreatment of cancer, yet the National Cancer Data Base (NCDB) indicates that 9.2% of patients receive no first course of treatment. Because the NCDB is limited to accredited cancer programs, there is potential for the actual rate to differ. We sought to understand the rate and characteristics of patients with cancer who receive no first course of treatment in a more population-representative data source.
  
  
  METHODS
  The Iowa Cancer Registry (ICR) strives to capture 100% of newly diagnosed cancer cases among Iowa residents, regardless of where they are diagnosed or treated.
  
  
  RESULTS
  In the ICR from 2004 to 2010, 12.3% of newly diagnosed patients with cancer did not receive a first course of treatment, which is 48% higher than the NCDB data for the state of Iowa (8.3%) during the same time period. Logistic regression indicated that nontreatment was more common in certain cancers (ie, small-cell and non-small-cell lung/bronchial cancers and low-grade non-Hodgkin lymphoma), advanced stages, older patients, those receiving treatment recommendations at nonaccredited cancer programs, and patients who never consulted an oncologist, radiation therapist, or surgeon. Distance to treatment facilities was not related to nontreatment.
  
  
  CONCLUSIONS
  The rate of nontreatment varies by cancer type and stage and is higher in patients receiving initial treatment recommendations in nonaccredited cancer programs than in accredited cancer programs. This pattern seems to be correlated with patient characteristics but also may be related to provider and facility characteristics available to people locally that influence both patient and provider decision making.
authors: University of Iowa, Iowa City, IA, USA. marcia-m-ward@uiowa.edu
authors: Marcia M
authors: MM
authors: Ward
authors: Fred
authors: F
authors: Ullrich
authors: Kevin
authors: K
authors: Matthews
authors: Gerard
authors: G
authors: Rushton
authors: Michael A
authors: MA
authors: Goldstein
authors: Dean F
authors: DF
authors: Bajorin
authors: Amy
authors: A
authors: Hanley
authors: Charles F
authors: CF
authors: Lynch
mesh_terms: D000068:Accreditation; D000368:Aged; D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007484:Iowa; D008297:Male; D008495:Medical Oncology / Q000592:standards / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012042:Registries
references: Ann Fam Med. 2007 Mar-Apr;5(2):105-11
references: 17389533
references: Am J Med Qual. 2012 Sep-Oct;27(5):434-40
references: 22205768
references: Psychooncology. 2005 Aug;14(8):636-46
references: 15744761
references: J Clin Oncol. 2009 Sep 1;27(25):4177-81
references: 19636004
references: J Fam Pract. 2001 Dec;50(12):1067
references: 11742609
references: Arch Surg. 2011 Oct;146(10):1128-34
references: 21690439
references: Cochrane Database Syst Rev. 2010 Nov 10;(11):CD006590
references: 21069689
references: J Rural Health. 2006 Spring;22(2):140-6
references: 16606425
references: Ann Oncol. 1998 Apr;9(4):365-74
references: 9636826
references: JAMA. 2010 Dec 1;304(21):2373-80
references: 21119084
references: JAMA. 1986 Jun 27;255(24):3385-90
references: 3712698
references: J Natl Cancer Inst. 2005 Oct 5;97(19):1407-27
references: 16204691
references: Med Oncol. 2011 Dec;28(4):1145-62
references: 20589539