title: Characteristics of the Delayed or Refusal Therapy in Breast Cancer Patients: A Longitudinal Population-Based Study in Taiwan.
abstract: BACKGROUND
  The evidence indicated breast cancer was a cancer with high survival rate. However, there were still some breast cancer patients delaying or refusing therapy. So we conducted a cohort study to explore the relationship between characteristics of breast cancer patients and delay or refusal of therapy within four months after cancer diagnosed.
  
  
  METHODS
  This was a retrospective national population-based study from 2004 to 2010 in Taiwan. This study included 35,095 patients with new diagnosis breast cancer from Taiwan Cancer Registry Database. Several analysis methods, including t test, Chi-square test, generalized estimating equations of logistic regression analysis, and Cox proportional hazards model, were performed to explore the characteristics of these patients and the relative risk of mortality with delay or refusal of therapy.
  
  
  RESULTS
  Our study showed that the overall survival rates were significantly different (p <0.05) between the breast cancer patients who delayed or refused therapy and those with treatment. The patients who delayed or refused therapy had lower 5-year overall survival rate compared with the treated group. The related factors included age, Charlson comorbidity index, cancer staging (OR = 1.30-19.69; p <0.05), other catastrophic illnesses or injuries and the level of diagnostic hospitals. However, the patients with different income levels and degree of urbanization in living area were not statistically significant factors.
  
  
  CONCLUSIONS
  Our results demonstrated that age and cancer staging were the main patient characteristics affecting whether the patients delayed or refused therapy. The delay or refusal of treatment was associated with the level of diagnosing hospital.
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Su Jing
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Kuang Hua
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Yueh-Hsin
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016312:Treatment Refusal