Study Looks at Complexity of Cancer Treatment Decisions

Published on July 11, 2014

A portrait of Marcia Ward of the University of Iowa College of Public Health.
Marcia Ward

Despite advances in the treatment of many cancers, a number of patients choose not to be treated. In Iowa, more than 12 percent of those who learn they have cancer don’t pursue treatment, according to research led by Marcia Ward, professor of health management and policy.

The researchers originally were focused on identifying the location of cancer specialists across the state and whether there were gaps in patient access to cancer treatment. While analyzing data from the Iowa Cancer Registry, the team was surprised to find that so many Iowans did not pursue treatment within the first year after diagnosis, according to Fred Ullrich, research specialist in the Department of Health Management and Policy.

“Treatment-seeking decisions are complex,” says Ullrich. “They’re based on a number of factors, and they are not necessarily dictated by remoteness of residence or distance to a treatment center.”

Along with the expected factors of advanced age or advanced stage of cancer, rates of non-treatment were also higher in patients who visited non-accredited cancer facilities and those who saw physicians who were not cancer specialists. Individuals with certain types of cancers that are known to progress slowly were less likely to pursue treatment, including stage 2 prostate cancer and non-Hodgkin lymphoma. While distance to treatment facilities did not seem to be a factor, rural Iowans were less likely to choose treatment.

Ullrich also notes that other factors, such as which patients choose to consult with specialists or seek treatment at an accredited facility, need to be better understood in order to address the issue of cancer non-treatment. Ward believes that the rate of non-treatment is higher than previously recognized, and that the rate in Iowans is similar to other states.