Dr Sundaresan on Reasons Why Patients With Pancreatic Cancer May Decline Treatment

Tilak Sundaresan, MD, hematologist and oncologist, chief, Oncology and Hematology, Kaiser Permanente, discusses findings from a retrospective cohort study investigating reasons why patients with pancreatic cancer may choose to forgo treatment.

At the 2024 ASCO Annual Meeting, Sundaresan and colleagues presented findings from a real-world chart review of adult patients with pancreatic ductal adenocarcinoma (PDAC) whose data were entered into the Kaiser Permanente Northern California Cancer Registry between 2010 and 2020. The analysis aimed to evaluate patient demographics, disease characteristics, and treatment decisions for this patient population. Data were collected for all patients under 65 years of age with nonmetastatic disease; from a random sample of 100 patients over 65 years of age with nonmetastatic disease who did not receive treatment; and from a random sample of 20 patients with metastatic disease who did not receive treatment.

Findings showed that among patients 65 years of age or younger, 90.3% of patients were evaluated by an oncologist, and 89.3% of this patient group were recommended subsequent treatment. Similar trends were observed for the group of patients above 65 years of age with nonmetastatic disease and those with metastatic PDAC. The primary reason for declining treatment across all groups was personal or family decision, Sundaresan notes, adding that this finding challenges the previously held notion that the decision to withhold treatment comes at the discretion of the physician.

Data showed that the primary reason for declining treatment in patients under 65 years of age with nonmetastatic disease was patient/family preference (80.8%), followed by PDAC-related frailty (11.5%) and the presence of additional medical comorbidities or other malignancies (7.69%).

Findings from this study serve as a prompt for clinicians to better understand how patients with pancreatic cancer approach the treatment decision-making process, Sundaresan says. These findings could help inform future research possibilities regarding treatment patterns and decisions for this patient population, he concludes.