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

## TL;DR

This study examines why about 40% of pancreatic cancer patients choose not to receive treatment, finding that most are elderly, in poor health, and have limited options for intervention.

## Contribution

The study provides a detailed analysis of untreated pancreatic cancer patients in Denmark, identifying key factors influencing treatment refusal.

## Key findings

- Most untreated patients were over 75 years old, in poor performance status, and had significant comorbidities.
- The median survival was 2 months, with 6% surviving one year, and clinical stage and performance status were key prognostic factors.
- Poor health, frailty, or patient choice explained 89% of treatment refusals, with limited modifiable factors identified.

## Abstract

This study aimed to assess the characteristics and reasons for opting out of treatment in the ~40% of patients with pancreatic cancer who are left untreated. We first assessed the completeness of registration and then obtained clinical data regarding patients residing in the North Denmark Region, included 2023/24 in the Danish Pancreas Cancer Database, registered as “no treatment”. Registration was 99% complete compared to the National Clinical Cancer Database. Of 91 patients, 79% were >75 years old, 2/3 were in poor performance status (PS), 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. Poor PS, frailty, or patients’ wishes explained 89% opting out of treatment, and 11% declined treatment without objective reasons. On a patient level, modifiable factors seem limited in this population.

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.