Dr Evans on the Influence on Patient Factors and Treatment Decisions in Pancreatic Cancer

Nicole S. Evans, MD, gastroenterologist, Kaiser Permanente, discusses factors that may prompt patients with pancreatic cancer to decline anticancer therapy in real-world, community-based practices.

At the 2024 ASCO Annual Meeting, Evans 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 goal of the analysis was to evaluate patient demographics, disease characteristics, and treatment decisions for this patient population. During the study, investigators examined charts for all patients under the age of 65, as well as a random sample of patients over 65 years of age with nonmetastatic disease who did not receive treatment and a random sample of 20 patients with metastatic disease who did not receive treatment.

Observations revealed that older patients were associated with a decreased likelihood to receive treatment, Evans says. Additionally, patients with metastatic disease also had a higher rate of comorbidities that were linked to decreased treatment rates, she continues

Among patients 65 years of age or younger with nonmetastatic disease who did not receive treatment, the primary reasons for declining therapy were patient and family preference (80.8%), PDAC-related frailty (11.5%), and medical comorbidities or other malignancies (7.69%). Similar trends were observed in patients over 65 years of age with nonmetastatic disease and in those with metastatic PDAC, with family/patient preference serving as the primary reason for declining treatment. Notably, race and gender were not associated with changes in treatment rates, Evans adds.

Based on the findings from the real-world study, Evans and colleagues concluded that these results could help guide the development of aids designed to help inform patients with pancreatic cancer of available treatment options. Guidelines could also help community practitioners better understand patient preferences and values when making a treatment decision.