Treatment rates and reasons for non-treatment in a real-world cohort of patients with pancreatic cancer.
Authors: Tilak Kumar Sundaresan, Nicole S Evans, Suraj Gupta, Lawrence Leung, Jeffrey Lee, Maily Wong, Stephen K. VanDenEeden
Journal: Journal of Clinical Oncology (2024)

e13554 Background: The proportion of patients who receive treatment for pancreatic ductal adenocarcinoma (PDAC) and reasons for non-treatment in real-world patient populations are poorly understood. Our study aims to determine treatment rates, predictors for non-treatment, and the rationale for declining treatment in a well-defined, diverse, community-based patient population. Methods: We identified all adult patients with PDAC (n = 3852) between 2010 and 2020 through the Kaiser Permanente Northern California Cancer Registry. Patients were stratified by age and tumor characteristics to determine rates of oncologic therapy. Multivariable logistic regression was used to assess how covariates were associated with receiving treatment. A detailed chart review of all patients ≤ 65 years and a random sample of 100 patients &gt; 65 years with non-metastatic disease who did not receive treatment was performed to better understand the reasons for non-treatment. A random sample of 20 patients with metastatic disease who did not receive treatment were also reviewed. Results: Of patients with PDAC, 77.7% of patients with non-metastatic and 56.2% with metastatic disease received any cancer-directed treatment. A multivariate analysis showed no statistically significant differences by race/ethnicity or gender. Increasing age was a significant negative predictor of treatment. Charlson comorbidity index (CCI) did not influence treatment rates in patients with non-metastatic PDAC, but in patients with metastatic disease those with CCI 3+ had a decreased odds of receiving treatment. Of patients ≤ 65 years with non-metastatic disease, 90.3% were seen by an oncologist, and of those patients 89.3% were offered treatment. The primary reason for declining treatment was patient/family preference in 80.8%, followed by PDAC-related frailty in 11.5%, and medical comorbidity/other malignancy in 7.69%. Similarly, of patients &gt; 65 years with non-metastatic disease, the majority were also seen by an oncologist, offered treatment, and declined due to personal preference. The same trends were noted in patients with metastatic PDAC. Conclusions: A significant proportion of patients with PDAC did not receive cancer-directed treatment in a real-world, community-based patient population, and this was more likely for patients with metastatic disease. Race and gender did not influence whether patients received treatment in this fully insured patient population and comorbidity had a small effect. Patients of increasing age, however, were less likely to receive treatment. Most patients who did not initiate treatment did so primarily due to patient/family preference despite being offered cancer-directed therapy by their treatment team. These findings may help guide the development and utilization of patient decision-aids in PDAC to improve goal concordant care that accounts for patients’ preferences and values.