Prevalence of non-treatment following pancreatic cancer diagnosis in the United States: A population-based analysis, 2016–2022.

e16357 Background: Pancreatic cancer is an aggressive malignancy for which cancer-directed therapy can improve outcomes when feasible. However, the proportion of patients who do not receive any cancer-directed treatment after diagnosis remains poorly characterized at the population level. We sought to quantify the prevalence of non-treatment following pancreatic cancer diagnosis and evaluate patient-level patterns and temporal trends over recent years. Methods: We conducted a retrospective population-based study using the Surveillance, Epidemiology, and End Results (SEER) database. Adults diagnosed with pancreatic cancer between 2016 and 2022 were included. Cancer-directed treatment was defined as receipt of chemotherapy, radiation therapy, or surgery of the primary tumor, as recorded in SEER. The primary outcome was receipt of no cancer-directed treatment. Non-treatment rates were evaluated overall and stratified by age, disease stage, race, and ethnicity. Temporal trends in non-treatment were assessed across the study period. Results: Among 95,315 patients diagnosed with pancreatic cancer, 39.7% received no cancer-directed treatment. Non-treatment increased markedly with age, affecting 26.7% of patients younger than 65 years, 34.2% of those aged 65–74 years, and 55.3% of patients aged 75 years or older. Notably, 41.2% of patients with localized disease did not receive cancer-directed therapy, while non-treatment was observed in 48.9% of patients with distant disease. Non-treatment rates varied modestly by race and were similar between Hispanic and non-Hispanic patients. Over time, non-treatment rates remained persistently high, ranging from 38.5% to 40.5% between 2016 and 2022, with no meaningful improvement observed. Among patients aged 75 years or older, non-treatment consistently exceeded 53% across all years. Conclusions: In this large population-based analysis, nearly two in five patients diagnosed with pancreatic cancer received no cancer-directed therapy, including a substantial proportion with potentially treatable disease. Non-treatment was particularly common among older adults and remained unchanged over time despite advances in systemic therapy and supportive care. These findings highlight a persistent care-delivery gap in pancreatic cancer and underscore the need for strategies to improve treatment access, referral, and decision-making, especially for older patients.