Factors and Considerations in No‐Treatment Decisions in Patients With Key Hematological Malignancies: A Nationwide, Population‐Based Study in the Netherlands: A Nationwide, Population-Based Study in the Netherlands

Comprehensive insights are lacking into why patients with hematological malignancies (HMs) receive no cancer‐directed treatment. We evaluated socio‐demographic and cancer‐related characteristics, decision‐making rationales, and overall survival in patients with three common HMs―diffuse large B‐cell lymphoma (DLBCL), symptomatic multiple myeloma (MM), and acute myeloid leukemia (AML)―who do not receive cancer‐directed treatment, using the nationwide Netherlands Cancer Registry. A total of 26 945 patients diagnosed with DLBCL (47%), symptomatic MM (29%), or AML (25%) between 2014 and 2021 were included. About 16% of the patients did not receive cancer‐directed treatment, ranging from 26% in AML to 15% in DLBCL and 10% in MM. The primary reason for not receiving cancer‐directed treatment in all three HMs was related to physical condition. The second main reason was patient/family choice in DLBCL and MM, whereas in AML it was rapid disease progression. In female patients, patient/family choice was a more prevalent reason for not receiving cancer‐directed treatment than in male patients. Patients with a lower socio‐economic position more often did not receive cancer‐directed treatment. Median OS varied by reason for not receiving cancer‐directed treatment, with the shortest OS in patients experiencing rapid disease progression or death before treatment initiation (0·4 to 0·6 months).