A patient at a crossroads, symbolizing the difficult decision of pancreatic cancer surgery, with paths representing different treatment options and highlighting disparities in access to care.

Unmasking the Barriers: Why Pancreatic Cancer Patients Forego Life-Saving Surgery

Samir D’Costa in Health & Wellness December 2025 • 5 min read.

"A Deep Dive into the Factors Influencing Treatment Decisions and How We Can Bridge the Gaps"

Pancreatic cancer is a formidable foe, and for those with resectable tumors, surgery offers the best chance of long-term survival. However, a significant number of patients who are eligible for surgery choose not to undergo this potentially life-saving procedure. Understanding the reasons behind these decisions is crucial to improving patient care and outcomes.

A recent study delved into the complex factors influencing the decision to refuse surgery for pancreatic adenocarcinoma. By analyzing data from a large cohort of patients, researchers have shed light on the disparities and biases that can impact treatment choices. The findings highlight the importance of addressing these barriers to ensure that all patients have access to the best possible care.

This article explores the key findings of the study, examining the roles of age, race, socioeconomic status, and other factors in the decision-making process. We will also discuss potential strategies to overcome these barriers and empower patients to make informed choices about their treatment options.

Why Are Patients Refusing Surgery? Unveiling the Complex Web of Factors

A patient at a crossroads, symbolizing the difficult decision of pancreatic cancer surgery, with paths representing different treatment options and highlighting disparities in access to care.

Several factors contribute to a patient's decision to decline surgery, even when it is recommended by their physician. These factors can be broadly categorized as:

Age plays a significant role, with older patients being more likely to refuse surgery. This could be due to concerns about their ability to tolerate the procedure, a perception that the benefits of surgery may not outweigh the risks, or inherent biases among patients, families, and even providers who may view surgery in the elderly as futile. However, studies have shown that appropriately selected older adults can undergo pancreas resection with similar outcomes to younger patients.

Perceived Risks and Benefits: Patients weigh the potential benefits of surgery against the perceived risks, considering factors such as the magnitude of the operation, the likelihood of complications, and the potential for cure.
Age and Comorbidities: Older patients, or those with significant health issues, may be hesitant to undergo major surgery due to concerns about their ability to tolerate the procedure and recover fully.
Socioeconomic Factors: Lower income, lack of insurance, and limited access to healthcare can all create barriers to accessing surgical treatment.
Racial Disparities: Studies have shown that African Americans are less likely to undergo surgical resection for pancreatic cancer, even when their tumors are considered resectable. This may be due to a combination of factors, including access to care, socioeconomic status, and implicit bias.
Personal Beliefs and Preferences: Patients' individual values, beliefs, and preferences also play a role in their treatment decisions. Some patients may prefer to pursue alternative therapies, while others may prioritize quality of life over potential survival benefits.

More troubling are the findings in this study and others that race, lower annual income, and marital status are associated with the decision to pursue curative-intent surgery. Married individuals are diagnosed earlier and benefit from improved overall survival (after controlling for stage at diagnosis and treatment), with the association between marital status and improved cancer survival likely related to higher socioeconomic status and better social support. Racial disparities for pancreas cancer are previously reported, with African Americans experiencing higher age-adjusted incidence and worse prognosis relative to Caucasians.

Empowering Patients, Bridging the Gaps: A Call to Action

Addressing the barriers to surgical resection of pancreatic cancer requires a multi-faceted approach. This includes improving access to healthcare for underserved populations, addressing socioeconomic disparities, and promoting culturally sensitive patient education. It also means acknowledging and addressing implicit biases within the healthcare system, ensuring that all patients receive equitable and informed care. Further examinations of patient preferences, and the optimal ways to support patients through this complex journey, are necessary.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1245/s10434-018-6981-9, Alternate LINK

Title: Barriers To Surgical Resection Of Pancreatic Adenocarcinoma

Subject: Oncology

Journal: Annals of Surgical Oncology

Publisher: Springer Science and Business Media LLC

Authors: Nicholas Latchana, Natalie Coburn

Published: 2018-11-07

Everything You Need To Know

What are the primary reasons why pancreatic cancer patients might choose to avoid surgery, even when it's recommended?

Several factors influence a patient's decision to decline surgery. These include perceived risks and benefits of the operation, the patient's age and existing health conditions (comorbidities), socioeconomic factors (income, insurance, and access to healthcare), racial disparities in treatment, and personal beliefs and preferences regarding medical interventions. All these factors are interconnected and can significantly impact a patient's choice to undergo potentially life-saving surgical resection for their pancreatic cancer.

How does a patient's age influence their decision to have surgery for pancreatic cancer?

Age significantly influences treatment decisions. Older patients are more likely to refuse surgery. This might be due to concerns about their ability to tolerate the procedure, a perception that the benefits might not outweigh the risks, or implicit biases. However, studies have shown that appropriately selected older adults can undergo pancreas resection with similar outcomes to younger patients. Therefore, age itself shouldn't be an absolute barrier; a thorough assessment of overall health is important.

In what ways do socioeconomic factors and racial disparities impact the treatment choices of individuals diagnosed with pancreatic cancer?

Socioeconomic factors, such as lower income, lack of insurance, and limited access to healthcare, create barriers to accessing surgical treatment. Racial disparities also play a significant role, with African Americans less likely to undergo surgical resection even when their tumors are resectable. This is attributed to a combination of factors, including access to care, socioeconomic status, and implicit bias within the healthcare system. These disparities highlight the need to address systemic issues to ensure equitable access to care for all patients with pancreatic cancer.

Can you elaborate on the role of personal beliefs and preferences in the context of surgery for pancreatic adenocarcinoma?

Patient's personal beliefs, values, and preferences profoundly influence their treatment choices. Some patients may opt for alternative therapies, while others prioritize quality of life over potential survival benefits. The complex nature of this decision necessitates patient-centered care, where healthcare providers respect and acknowledge individual patient preferences. This approach involves providing comprehensive information about the risks, benefits, and alternatives associated with surgery, while also addressing any emotional or spiritual concerns patients may have.

What specific strategies can be implemented to empower patients and bridge the gaps that prevent them from accessing potentially curative surgical resections for pancreatic cancer?

Addressing the barriers to surgical resection requires a multi-faceted approach. This includes improving healthcare access for underserved populations, addressing socioeconomic disparities, and promoting culturally sensitive patient education. It also involves acknowledging and addressing implicit biases within the healthcare system. Furthermore, continuous examination of patient preferences and optimal support strategies is necessary. A collaborative effort is needed to ensure that all patients receive equitable and informed care, empowering them to make the best decisions for their health, considering factors such as age, race, and socioeconomic status.