He socioeconomic status such as low-income and different salary did not have influences on delay or refusal of therapy. Therefore, it is obvious that socioeconomic status is not the main reason of delay or refusal of therapy for Taiwanese breast cancer patients. According to previous studies on other countries, the minority (Hispanic and African American) were more likely to fpsyg.2017.00209 delay or refuse therapy, and had higher relative risk of mortality [10, 40], because of lack of insurance or low socioeconomic status [40]. The economic burden of medical care of cancer is usually the point of impact on delay or refusal of therapy for cancer patients [3, 41]. The differences in reasons for delay or refusal of therapy may stem from the diversity in healthcare policies in different countries. In the Taiwanese National Health Insurance system, the minority cancer patients such as the group of low income were provided with subsidy such waiver of deductibles to guarantee the accessibility of medical care and the rights. In addition, all cancer patients were exempted from copayment for cancer treatments in Taiwan National Health Insurance system. The diversities of healthcare system and polices between countries may be the reason why findings regarding to delay and refuse therapy by breast cancer patients in the current study are significantly different from earlier researches. The overall survival of breast cancer patients following treatment is thus affected [10, 11, 42]. This study found that regarding to cancer severity, the ratio of delay or refusal of therapy was higher for more advanced breast cancer patients. In consistent with earlier study (delay of therapy for 60 days), the risk of mortality by delay of therapy was higher for patients with advanced cancer than those at early stage [42]. In terms of comorbidity by Charlson comorbidity index (CCI), the ratio of delay or refusal of therapy was also higher for the patients with CCI7. Previous studies also showed that patients with terminal cancers were more likely to refuse therapy, furthermore, some were even reluctant to accept further examination to get aPLOS ONE | DOI:10.1371/journal.pone.0131305 June 26,7 /Delayed or Refusal Therapy in Breast Cancer PatientsTable 2. Analysis of logistic regression model with generalized estimating wcs.1183 equations for the correlations between patient choice and patient characteristics in breast cancer patients. Variables Age at diagnosed 44 (reference) 45?4 55?4 65?4 75 Monthly salary (NTD) 17280(reference) Insured dependent 17281?2800 22801 Insurance Status Employees/employers (reference) Farmers or fishers Low-income household Unemployed, retired, Resiquimod site others Urbanization level of residence location Level 1 (reference) Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Level of diagnosing purchase Velpatasvir Hospital Medical center (reference) Regional hospital District hospital Primary medical clinic Hospital ownership Public (reference) Private CCI score 0? (reference) 4? Above 7 Other catastrophic illnesses or injuries without (reference) with Staging Stage I (reference) Stage II Stage III Stage IV Note: Event: delay or refusal of treatment doi:10.1371/journal.pone.0131305.t002 1.30 1.95 19.69 1.11 1.55 14.59 1.54 2.44 26.58 0.002 <0.001 <0.001 1.58 1.16 2.16 0.004 1.30 1.14 1.13 0.94 1.48 1.39 <0.001 0.181 0.94 0.68 1.30 0.716 2.08 1.77 1.52 1.49 1.28 1.06 2.86 2.46 2.16 <0.001 0.001 0.021 0.95 0.93 0.77 0.99 0.83 0.71 0.82 0.74 0.60 0.63 0.61 0.49 1.11 1.19 1.00 1.55 1.14 1.03 0.494.He socioeconomic status such as low-income and different salary did not have influences on delay or refusal of therapy. Therefore, it is obvious that socioeconomic status is not the main reason of delay or refusal of therapy for Taiwanese breast cancer patients. According to previous studies on other countries, the minority (Hispanic and African American) were more likely to fpsyg.2017.00209 delay or refuse therapy, and had higher relative risk of mortality [10, 40], because of lack of insurance or low socioeconomic status [40]. The economic burden of medical care of cancer is usually the point of impact on delay or refusal of therapy for cancer patients [3, 41]. The differences in reasons for delay or refusal of therapy may stem from the diversity in healthcare policies in different countries. In the Taiwanese National Health Insurance system, the minority cancer patients such as the group of low income were provided with subsidy such waiver of deductibles to guarantee the accessibility of medical care and the rights. In addition, all cancer patients were exempted from copayment for cancer treatments in Taiwan National Health Insurance system. The diversities of healthcare system and polices between countries may be the reason why findings regarding to delay and refuse therapy by breast cancer patients in the current study are significantly different from earlier researches. The overall survival of breast cancer patients following treatment is thus affected [10, 11, 42]. This study found that regarding to cancer severity, the ratio of delay or refusal of therapy was higher for more advanced breast cancer patients. In consistent with earlier study (delay of therapy for 60 days), the risk of mortality by delay of therapy was higher for patients with advanced cancer than those at early stage [42]. In terms of comorbidity by Charlson comorbidity index (CCI), the ratio of delay or refusal of therapy was also higher for the patients with CCI7. Previous studies also showed that patients with terminal cancers were more likely to refuse therapy, furthermore, some were even reluctant to accept further examination to get aPLOS ONE | DOI:10.1371/journal.pone.0131305 June 26,7 /Delayed or Refusal Therapy in Breast Cancer PatientsTable 2. Analysis of logistic regression model with generalized estimating wcs.1183 equations for the correlations between patient choice and patient characteristics in breast cancer patients. Variables Age at diagnosed 44 (reference) 45?4 55?4 65?4 75 Monthly salary (NTD) 17280(reference) Insured dependent 17281?2800 22801 Insurance Status Employees/employers (reference) Farmers or fishers Low-income household Unemployed, retired, others Urbanization level of residence location Level 1 (reference) Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Level of diagnosing hospital Medical center (reference) Regional hospital District hospital Primary medical clinic Hospital ownership Public (reference) Private CCI score 0? (reference) 4? Above 7 Other catastrophic illnesses or injuries without (reference) with Staging Stage I (reference) Stage II Stage III Stage IV Note: Event: delay or refusal of treatment doi:10.1371/journal.pone.0131305.t002 1.30 1.95 19.69 1.11 1.55 14.59 1.54 2.44 26.58 0.002 <0.001 <0.001 1.58 1.16 2.16 0.004 1.30 1.14 1.13 0.94 1.48 1.39 <0.001 0.181 0.94 0.68 1.30 0.716 2.08 1.77 1.52 1.49 1.28 1.06 2.86 2.46 2.16 <0.001 0.001 0.021 0.95 0.93 0.77 0.99 0.83 0.71 0.82 0.74 0.60 0.63 0.61 0.49 1.11 1.19 1.00 1.55 1.14 1.03 0.494.