Sometimes some of us just simply decide that we will not start any treatment or continue a treatment protocol simply because we don’t want to have treatment.  This type of decision is different from our deciding that a specific treatment has too many side effects for the potential upside it might provide.

Researchers set out to identify psychosocial variables and characteristics associated with cancer treatment default. They hypothesized that cancer patients who are psychologically distressed are more likely to default or: (a) refuse, delay or discontinue cancer treatment and routine patient follow up, and (b) decline offers for psychological support.

A total of 467 consecutive adult cancer patients (all cancers including prostate cancer) attending scheduled oncology follow-ups at a single academic medical center completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so.

A total of 159 of 467 (34.0%) subject cancer patients were defaulters. Of these 159 defaulters, 89 (55.9%) desired psychological support, compared to only 13 (4.22%) of 308 non-defaulters. Although not associated with each other, desire for psychological support and psychological distress were the only variables found to be significantly associated with default of appointment or cancer treatment. No other remarkable differences between defaulters and non-defaulters were discerned.

The results showed that cancer treatment defaulters had a higher psychological distress but greater desire for support compared to non-defaulters.

In conclusion cancer patients who refuse cancer treatment initially should be offered psychological support, with their desire for treatment re-evaluated later on. Patients may be more willing to accept cancer treatment if desirous of and given psychological support. This in turn could potentially increase treatment acceptance rates and improve survival.

If you are a defaulting prostate cancer survivor or if a man in your care is a defaulter make sure that he is offered psychological support.  It still remains his decision whether to seek or continue treatment, but give him an opportunity to explore his feelings and his options.

J Clin Oncol 32:5s, 2014 (suppl; abstr 9567); Caryn Mei-Hsien Chan, Wan Azman Wan Ahmad, Mastura Md Yusof, Gwo Fuang Ho, Edward Krupat.

Joel T Nowak, M.A., M.S.W.