Characteristics, Prognosis and Reasons for Opting-Out of Treatment in Patients with Untreated Pancreatic Cancer.

Background

About 40% of patients with pancreatic cancer (PC) are left untreated. Identification of the modifiable factors for opting out could increase the number eligible for treatment.

Methods

We first assessed the completeness of registration. Next, we identified patients residing in the North Denmark Region, included 2023/24 in the Danish Pancreas Cancer Database (DPCD), registered as "no treatment". We supplemented register data with health record data, including reasons for opting out of treatment.

Results

Registration in DPCD was complete compared to the National Clinical Cancer Database, except for one patient. Six patients had other tumors. Of a total of 91 patients, 79% were >75 years old, 2/3 were in performance status (PS) > 2, more than half were socially or physically fragile, while 42% had significant comorbidity. Only 20% were referred to an oncologist. The median overall survival was 2 months, and the 1-year survival was 6%. Clinical stage and PS were prognostic in multivariable analysis. In 70%, poor PS was a reason for opting out of treatment, while 11% declined treatment without objective reasons.

Conclusions

Poor PS, frailty, or patients' wishes explained 89% opting out of treatment. On a patient level, modifiable factors seem limited in this population.