• Mark J Stavas, Kyle O Arneson, Matthew S Ning, Albert A Attia, Sharon E Phillips, Stephanie M Perkins, and Eric T Shinohara.
• Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: mark.j.stavas@vanderbilt.edu.
• J Pain Symptom Manage. 2015 Jun 1; 49 (6): 1081-1087.e4.

ContextPatients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting.ObjectivesTo investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC.MethodsPatients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting.ResultsA total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended.ConclusionPatients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted.Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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