Some patients with cancer will occasionally refuse therapy, particularly when their situation is considered hopeless. I thought that this was largely an attitude of the past until I came across a recent article about patients saying "no" to therapy (see: Lung Cancer Survival Shortens as Patients No' to Tx). Below is an excerpt from it:
The number of patients with advanced lung cancer who decide not to undergo treatment is increasing despite better systemic treatments that are more tolerable and that significantly improve overall survival....Analysis of data from the National Cancer Database reveals that from 1998 to 2012, 21% of patients with primary non–small cell lung cancer (NSCLC) received no treatment, resulting in significantly shorter overall survival....regardless of disease stage....The proportion of untreated patients with NSCLC ranges from 7% to 45% depending on stage. However, up to 90% of older, medically inoperable patients do not receive treatment....There are many factors that influence the decision not to undergo treatment for NSCLC, including patient and disease characteristics, as well as physician referral patterns and preferences,....Physicians should make sure that "patients from disparate populations are evaluated and counseled thoroughly by multidisciplinary teams before choosing to forego treatment for NSCLC...." Many patients who are diagnosed with NSCLC may not be aware of the dramatic differences in survival between treated and untreated patients and believe that cancer treatment is worse than the disease....For a lot of patients, that isn't true anymore, so treatment options should be fully explored before patients decide not to have any treatment....It is also important for clinicians "to recognize the stigma that NSCLC still carries despite efforts to fight it and the negative influence that the stigma can have on perception of the disease and treatment.
A patient's cultural background and personality play a highly significant role in his or her attitude toward cancer and its treatment. Such attitudes are also present for caregivers and need to be taken into consideration. Here's an interesting quote from an article on medical decision-making (see: Role of Culture in Healthcare Decision-Making):
Conflict related to cultural beliefs within healthcare commonly arises during times of significant life change....Our American principles of bioethics are based on Western beliefs, principally that of autonomy, having respect for the individual and honoring their ability to make decisions on their own behalf. However, other cultures such as those from Eastern origins are very sociocentric and are family-centered. There is a greater sense of collectivism, interdependence, and community. These values highly influence decision-making.
In the case of lung cancer, some cultures may signal that it's hopeless to fight, resulting in a refusal of therapy. Other factors may come into play such as the anticipated quality of life during treatment, fear of one's family being burdened by the cost of care, or devaluing the extra months of life gained under treatment. It's also the bias of most healthcare professionals to treat and extend life even for patients who express reservations about treatment. This can cause friction with treating physicians and nurses when therapy is refused.