Abstract:
Purpose: Signicant proportions of patients either refuse or discontinue radiotherapy, even in the
curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie
decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka.
Methods: An exploratory descriptive qualitative study was carried out among 14 purposively-selected
patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were
transcribed in Tamil, translated into English, coded, and thematically analyzed.
Results: All participants referred to radiotherapy as “current” with several understanding the procedure to
involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare
providers, who were perceived to focus on side effects without explaining the procedure. In the absence
of these crucial details, patients relied on family members and acquaintances to ll these information
gaps, often based on second- or third-hand accounts of experiences with radiotherapy. Many felt
pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for
others COVID-19 was an impediment. All but three participants regretted their decision, claiming they
would recommend radiation to patients with cancer, especially when it is offered with curative intent.
Conclusion: Patients with cancer who refused/discontinued radiation therapy have signicant
information needs. While human resource decits need to be addressed in low-resource settings like
northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save
resources that would otherwise be wasted on patient preparation for radiotherapy.
