肿瘤患者拒绝放射疗法（RT）虽然不频繁，但意义重大，因为它预示着不良的治疗结果。以联邦定义的五个人种类别作为研究对象的拒绝RT的先前研究尚无。本研究利用代表全国的大型人口对癌症患者进行研究，确定：1）哪个种族的患者最常拒绝RT；2）与种族相关的RT拒绝的预测因素。回顾性研究包括2004年至2017年之间确诊癌症的年龄≥18岁的患者，使用国家癌症数据库。所有被纳入研究的患者都曾被医生建议首选RT治疗。通过多变量 logistic 回归分析RT拒绝情况（调整后的赔率比[aOR]）和95%置信区间（95%CI）。分析结果根据患者因素（年龄、住所、收入、教育和合并疾病）和癌症特征（阶段、癌症类型、医疗机构类型、诊断年份和地区）进行调整。使用 Kaplan-Meier 方法计算中位总生存期。在 11609044 名患者中，2759753 名患者被纳入研究并被治疗医生建议进行RT治疗。中位随访时间为50个月。139383 位患者（5%）拒绝RT，拒绝率有所不同：416 名 NHPI（7.2%）、489 名 AIAN（5.8%）、118186 名非西班牙裔白人（5.0%）、17427 名黑人（4.8%）和2865 名亚洲人（4.8%）。年度RT拒绝率不断上升，尤其是 NHPI 患者。最可能拒绝RT的族群是 NHPI（aOR = 1.53，95% CI = 1.36-1.71）、AIAN（aOR = 1.24，95% CI = 1.12-1.37）和黑人（aOR = 1.11，95% CI = 1.09-1.14），与非西班牙裔白人患者相比。对于所有种族，年龄较大和合并疾病负担较高预测RT拒绝。拒绝RT和接受RT的患者的中位总生存期分别为81个月和144个月。本研究显示，土著和黑人患者更有可能拒绝RT，这可能导致较差的癌症治疗结果。了解 NHPI 和 AIAN 患者的观点和看法可能有助于减轻这些不平等。版权所有©2023 Elsevier Inc。

Radiation therapy (RT) refusal by patients with cancer is infrequent but is significant because it portends poor outcomes. No prior study has evaluated all five federally defined racial categories with respects to RT refusal. Here we use a large nationally representative population with cancer to determine: 1) which race of patients refuse RT the most and 2) predictive factors for RT refusal by race.A retrospective study included patients ≥18 years old with diagnostically confirmed cancer between 2004-2017, using the National Cancer Database. All patients included were offered RT for first course treatment. Multivariable logistic regression assessed RT refusal (adjusted odds ratio [aOR]) with 95% confidence intervals (95%CI). Analyses were adjusted for patient factors (age, rurality, income, education, and comorbidities) and cancer characteristics (stage, cancer type, facility type, year of diagnosis, and region). Median overall survival was calculated using the Kaplan-Meier method.Of 11,609,044 patients, 2,759,753 patients were included and recommended for RT by the treating physician. Median follow-up was 50 months. RT was refused by 139,383 patients (5.0%), varying by race: 416 NHPI (7.2%), 489 AIAN (5.8%), 118,186 Non-Hispanic White (5.0%), 17,427 Black (4.8%), and 2,865 Asian (4.8%) patients. The rates of annual RT refusal were increasing, especially among NHPI patients. The populations with the highest likelihood of refusing RT were NHPI (aOR=1.53, 95%CI=1.36-1.71), AIAN (aOR=1.24, 95%CI=1.12-1.37), and Black (aOR=1.11, 95%CI=1.09-1.14) patients, compared to Non-Hispanic White patients. Older age and higher comorbidity burden predicted RT refusal across all races. Median overall survival was 81 months and 144 months for patients who refused RT and received RT, respectively.Indigenous and Black patients are more likely to refuse RT, which may contribute to inferior cancer outcomes. Understanding NHPI and AIAN patient perspectives and perceptions may elucidate interventions to mitigate these disparities.Copyright © 2023. Published by Elsevier Inc.