Introduction

Cancer incidence and mortality rates have been rising in China, and starting from 2010, cancer has become the number one cause of death in China and a major public health problem in the country1. In this past year alone, lung cancer occurred in approximately 135,000 patients, and it was responsible for 132,000 deaths in the United States2. Lung cancer has remained the leading cause of cancer deaths worldwide3.

Thus far, the four main treatments for lung cancer are surgery, radiotherapy, chemotherapy, and bio-targeted therapy4,5,6,7,8. Patients with early lung cancer, that is stages 1 and 2, could first consider surgical treatment in accordance with the treatment norms9,10. Adjuvant treatment after surgery and inoperable lung cancer need radiotherapy and chemotherapy11. According to statistics, approximately 60% of all patients with lung cancer may need to accept radiotherapy and chemotherapy, which play a very important role in the treatment of lung cancer12. Radiotherapy and chemotherapy could kill cancer cells and reduce the chance of spreading13,14. A certain course of radiotherapy and chemotherapy treatment could improve the control of the disease, and it has a positive treatment significance for delaying the development speed of the disease and improving the quality of life15. For various reasons such as anxiety, worry about the quality of life, many patients with lung cancer are not willing to accept radiotherapy and chemotherapy treatment16,17. In order to improve the quality of life of lung cancer patients, it is necessary for clinicians to make the best diagnosis and treatment plan for lung cancer patients, and to further understand the influencing factors of lung cancer patients receiving radiotherapy and chemotherapy. In some past studies, it has been shown that the most important factors affecting patients receiving chemotherapy are age, sex, financial status, whether reimbursement is provided, rural and urban of patients. Logistic regression analysis generally starts with a univariate analysis, which can provide information about the characteristics of the data distribution. The main purpose of univariate analysis is to explore the form of independent variables into the model to better describe the relationship between dependent variables and the second, some potentially meaningless variables can be eliminated to reduce the number of variables in multivariate analysis and ensure the stability and simplicity of the results. Multivariate analysis is more complex than univariate analysis, and it is favored by researchers, considering the correlation among various variables. In the present study, to understand the degree of acceptance of radiotherapy and chemotherapy for patients with lung cancer, the intention of recent patients with lung cancer to accept radiotherapy and chemotherapy was investigated. Logistic regression analysis of the influencing factors was also conducted to provide useful information for clinicians to carry out targeted and effective treatment for the benefit of more patients.

Methods

Setting, participants, and study design

A total of 160 patients with lung cancer who were hospitalized at the Binzhou Medical University Hospital from January 2020 to June 2021 were randomly selected. The inclusion criteria were as follows: pathologically diagnosed with lung cancer, with informed consent, and under voluntary cooperation. Patients with cognitive dysfunction were excluded. This study was approved by the Ethics Committee.

The research team consulted the literature; investigated doctors, nurses, patients, and managers; and conducted expert demonstration to form a questionnaire. The research content included whether to accept radiotherapy and chemotherapy, gender, age, cultural level, own personality, own income, acceptance of payment ratio, family economy, self-care ability, disease course classification, understanding of radiotherapy and chemotherapy, own attitude towards disease treatment, family attitude towards disease treatment, and knowledge of lung cancer. The investigation study was divided into two groups on the basis of whether to accept radiotherapy and chemotherapy. The questionnaire belongs to a descriptive study.

Data analysis

SPSS 25.0 software was used in all statistical analyses. The observation data were counting data, represented by examples. The factors in the questionnaire data of patients accepting and not accepting radiotherapy and chemotherapy were compared for univariate analysis. χ2 test was used to compare the differences between groups. Multifactor logistic regression analysis was conducted to analyze two statistically significant groups, the influencing factors of radiotherapy and chemotherapy among patients with lung cancer were explored, and a predictive model was established. The receiver operating characteristic (ROC) curve was used to determine the predictive value of the regression model. P < 0.05 indicated statistically significant difference.

Ethics approval and consent to participate

The study was reviewed and approved by the Review Boards of the Binzhou Medical University Hospital. The research methods and questionnaires used in this study were performed in accordance with the relevant guidelines of Binzhou Medical University Hospital on scientific research and the regulations of Binzhou Medical University Hospital on questionnaire survey and return visit. All participants agreed to and signed the written informed consent form prior to enrollment into the study.

Results

General information

In this survey, 160 questionnaires were issued, and 160 questionnaires were recovered, with a recovery rate of 100%. Upon excluding incomplete questionnaires, 153 questionnaires were analyzed, with an efficiency of 95.63%. A total of 96 questionnaires belonged to the accept group (62.75%), and 57 questionnaires belonged to the not-accept group (37.25%).

Univariate analysis of the two groups

In the two groups of data, age, own personality, own income, family economy, self-care ability, disease course classification, understanding of radiotherapy and chemotherapy, own attitude towards disease treatment, family attitude towards disease treatment, and knowledge of lung cancer showed statistical significance (P < 0.05). On the contrary, gender, cultural level, acceptance of payment ratio exhibited no statistically significant difference (P > 0.05), as shown in Table 1.

Table 1 Univariate analysis of two groups data.
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Multifactor logistic regression analysis

This study established a multi-factor logistic regression model to determine whether or not to receive radiotherapy and chemotherapy is the stress variable, assigned as 1 = yes and 2 = No. The indicators of P < 0.05 in the univariate analysis (Table 1) were taken as independent variables. Age, own personality, and other 10 factors were taken as independent variables (variable assignment in Table 2). The regression process adopted gradual regression method and included independent variable selection and elimination. P > 0.05 values were excluded, while P < 0.05 values were selected.

Table 2 Multi factor assignment table.
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Regression results. The multifactor logistic regression analysis found that own personality, self-care ability, disease course classification, own attitude towards disease treatment, and family attitude towards disease treatment were factors affecting the radiotherapy and chemotherapy of patients with lung cancer. As shown in Table 3, the prediction model expression is as follows: Logit (P) =  − 18.785 + 1.854X1 + 1.93X2 + 1.691X3 + 2.03X4 + 2.418X5, where covariates X1, X2, X3, X4, and X5 refer to own personality, self-care ability, disease course classification, own attitude towards disease treatment, and family attitude towards disease treatment, respectively.

Table 3 Analysis results of logistic regression by gradual regression method.
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Comparison of ROC curves of prediction model and various factors

The area under the ROC curve of the predicted model was 0.973, the 95% confidence interval (CI) was 0.952–0.995, the optimal critical value was 0.832, the sensitivity was 91.84%, the specificity was 89.09%, and the accuracy was 90.85%. Further details are shown in Table 4 and Fig. 1.

Table 4 Value of predictive model and various factors.
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Figure 1
figure 1

ROC curve of the predictive model and the various factors. The area under the ROC curve of the predicted model was 0.973.

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Discussion

As a clinically important treatment means and strategy, the radiotherapy and chemotherapy for lung cancer, similar to other treatment methods, has advantages and disadvantages18,19. They reflect the basic principles of multidisciplinary comprehensive treatment of tumors20. Patients have the greatest clinical benefit, which could not only quickly remove peripheral circulating cancer cells and hidden metastatic metastases but also rapidly reduce local primary lesions to relieve local oppression and local invasion symptoms and improve the quality of life of patients21. Clinically, the side effects of radiotherapy and chemotherapy could not be underestimated, including the so-called body injury side, such as eating difficulties caused by radioactive esophagitis22, cough and breathing difficulties caused by radioactive pneumonia23, abnormal brain cognitive behavior caused by radiotherapy and chemotherapy24, and gastrointestinal dysfunction25. Doctors need to weigh the pros and cons clinically, combined with the situation of the family members, and make calm and rational choices rather than the same synchronization26. A specific individualized treatment plan must be established in accordance with each patient’s own situation, psychological condition, the disease itself, and the specific situation of the family members..

Univariate analysis of the two groups of data showed statistical significance in age, own personality, own income, family economy, self-care ability, disease course classification, understanding of radiotherapy and chemotherapy, own attitude towards disease treatment, family attitude towards disease treatment, and knowledge of lung cancer (P < 0.05), whereas no statistical difference was found in gender, cultural level, and acceptance of payment ratio (P > 0.05). The findings demonstrated that these three factors have no effect on whether or not patients with lung cancer accept radiotherapy and chemotherapy. Further logistic regression analysis of factors with statistical significance found that five indicators, such as own personality, self-care ability, disease course classification, own attitude towards disease treatment, and family attitude towards disease treatment, were retained in the regression model (P < 0.05). Age, income, family economy, understanding of radiotherapy and chemotherapy, and knowledge of lung cancer were excluded. In the past 10 years, the level of population education in China has made a new and relatively significant leap, and we can gain more "population quality dividend" in the era of the popularization of higher education. The improvement of people's education level has enhanced the understanding of disease treatment, and given full play to their own initiative.

In Chinese custom, a previous preference for men over women exists. However, in this study, gender was not an influencing factor, indicating that Chinese people today have basically eliminated the preference for men over women and treat both genders equally. Age was also not an influencing factor, indicating that the idea of respecting and loving the elderly in traditional social culture has always existed and that treatment has not been given up because of their old age, different from the African diaspora27. All of the above factors were not affected by the level of knowledge and culture. Therefore, cultural level was excluded. Acceptance of payment ratio, own income, and family economy were three factors related to treatment cost, which was not an influencing factor as it did not affect whether or not patients with lung cancer accept radiotherapy and chemotherapy. Treatment cost is related to the improvement of people’s living standards, the substantial growth of gross national product, and the implementation of national medical care since the reform and opening up. The understanding of radiotherapy and chemotherapy and the knowledge of lung cancer were not included, indicating that treating a disease is necessary, seeing a doctor is deeply rooted in the hearts of sick people, and the people’s awareness of seeking medical treatment is gradually improved28. Logistic analysis showed that among the five factors, own personality, which is a psychological factor; self-care ability; disease classification, which is the disease itself; and own and family attitudes towards disease treatment further affected the decision of patients with lung cancer to accept radiotherapy and chemotherapy factors. The above factors could help clinicians determine further treatment.

The limitations of the study are based on a small sample size belonging to a population of cultural background (China). If the same study were conducted in the populations of other countries of different cultural, economic, and social environments, then the results would be different outcomes. It would be impactful if such studies and models were used for similar objectives in different parts of the world to have a more wholesome understanding of influencing factors. In the future, we will further expand the sample size, increase the depth and breadth of the questionnaires, introduce more effects into the study, and improve the reliability of the conclusions.

Conclusions

The five indicators (including own personality, self-treatment ability, disease course classification, own attitude towards the treatment of disease, and family attitude towards the treatment of disease) are the main factors for accepting radiotherapy and chemotherapy treatment among patients with lung cancer. The predictive model based on logistic regression analysis could better predict the extent of accepting radiotherapy and chemotherapy. Understanding the factors related to patients with lung cancer could provide useful information for the targeted and effective treatment by clinicians.