Predictors of Surgery Refusal in Pancreatic Cancer Patients – A Review

Abstract

Surgical resection for pancreatic cancer has the potential to improve survival outcomes, yet some patients will refuse this treatment. An understanding of predictive factors for surgery refusal in this patient group would be useful in guiding the development of interventions to reduce surgery refusal rates. The objective of this research was to collate, review, assess and summarize the published literature on predictors of surgery refusal in pancreatic cancer patients. A systematic literature search was conducted using PubMed and Scopus to identify relevant literature published between 1 January 2000 and 31 December 2023. A hand search of reference lists was also conducted. Manuscripts were assessed for eligibility using predefined eligibility criteria. Data collected from each eligible study included study country, population characteristics, mortality/survival outcomes and rates and predictors of surgery refusal. The Newcastle-Ottawa Scale was used to assess study quality. There were seven manuscripts (seven studies) included in this review. All studies were from the United States, were cohort studies, and were of good quality. Surgery refusal rates ranged from 1%-7.8%. Most studies confirmed that surgery refusal was associated with lower survival. A mix of sociodemographic, access to healthcare, and clinical factors were linked to surgery refusal, of which race (85.7%), age (57.1%), healthcare insurance (57.1%) and treatment facility type (57.1%) were the most frequently reported factors. Surgery refusal in pancreatic cancer patients is multifactorial. The information from this review has implications for designing risk reduction interventions and risk models for surgery refusal in pancreatic cancer patients.