Abstract B061: Evaluating the Burden of Untreated Pancreatic Cancer

Abstract Introduction: Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest malignancies with a 12% 5-year survival rate, worsened by frequent late diagnosis (median age: 71). Survival estimates of patients with pancreatic cancer are frequently assessed for cohorts eligible for treatment. To generate preliminary data for an early detection initiative, we annotated the natural history of patients diagnosed with PDAC to calculate the proportion of our population who receive no treatment. We hypothesized patients receiving no treatment would be primarily driven by late-stage diagnosis, comorbid conditions, and disparities in care access. Methods: Retrospective, IRB reviewed chart review analysis of pancreatic cancer patients identified by the Northwell Health cancer registry between 2021 and 2023 at Northwell Health. Variables included age, diagnosis year (2021-2023), histology, and treatment status. Among 1718 patients who were diagnosed between 2021-2023, 523 patients did not receive any treatment at Northwell. A random sample of 224 patients was reviewed manually and characterized as untreated: initiation management by hospice, poor functional status, multiple comorbidities; or as unknown: transferred to another health system, lost to follow-up. Kaplan-Meier survival analysis and log-rank tests were used to compare verified untreated and unverified treatment groups. Results: Of 224 patients, 59% (n=133) were confirmed untreated. Primary barriers were hospice (46.6%, n=62), low functional status (27.1%, n=36), and comorbidities (6.0%, n=8). There were 70 patients (31.2%) who had unknown status due to transfers/lost to follow-up, comprising 20% (n=46) patients transferred to another facility and 10.7% (n=24) patients were lost to follow-up. Untreated patients had a median survival rate of 1 month. Conclusion: This study identified the frequency and mortality of untreated patients with PDAC. Astonishingly, 59% of patients with a biopsy confirmed PDAC diagnosis never received treatment. This finding highlights the need for system-level solutions including earlier detection protocols for high-risk patients, less toxic therapies for low performance status populations, and care coordination to reduce delays in transfers or losses in follow-up. Ongoing efforts should focus on such care coordination gaps. Citation Format: Adrianna Kapusta, Shuyi Chen, Neecki Zand, Daniel King. Evaluating the Burden of Untreated Pancreatic Cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research—Emerging Science Driving Transformative Solutions; Boston, MA; 2025 Sep 28-Oct 1; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_3):Abstract nr B061.