Pancreatic enzyme replacement therapy in patients with pancreatic cancer : A national prospective study

Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved..

OBJECTIVE: UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates.

DESIGN: RICOCHET was a national prospective audit of malignant pancreatic, peri-ampullary lesions or malignant biliary obstruction between April and August 2018. This analysis focuses on pancreatic cancer patients and is reported to STROBE guidelines. Multivariable regression analysis was undertaken to assess factors associated with PERT prescribing.

RESULTS: Rates of PERT prescribing varied among the 1350 patients included. 74.4% of patients with potentially resectable disease were prescribed PERT compared to 45.3% with unresectable disease. PERT prescription varied across surgical hospitals but high prescribing rates did not disseminate out to the respective referring network. PERT prescription appeared to be related to the treatment aim for the patient and the amount of clinician contact a patient has. PERT prescription in potentially resectable patients was positively associated with dietitian referral (p = 0.001) and management at hepaticopancreaticobiliary (p = 0.049) or pancreatic unit (p = 0.009). Prescription in unresectable patients also had a negative association with Charlson comorbidity score 5-7 (p = 0.045) or >7 (p = 0.010) and a positive association with clinical nurse specialist review (p = 0.028).

CONCLUSION: Despite national guidance, wide variation and under-treatment with PERT exists. Given that most patients with pancreatic cancer have unresectable disease and are treated in non-surgical hospitals, where prescribing is lowest, strategies to disseminate best practice and overcome barriers to prescribing are urgently required.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - year:2021

Enthalten in:

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al. - (2021) vom: 25. Mai

Sprache:

Englisch

Beteiligte Personen:

RICOCHET Study Group on behalf of the West Midlands Research Collaborative [VerfasserIn]

Links:

Volltext

Themen:

Dietitian
Enzyme replacement
Journal Article
Pancreas
Pancreatic cancer
Pancreatic resection

Anmerkungen:

Date Revised 22.02.2024

published: Print-Electronic

Citation Status Publisher

doi:

10.1016/j.pan.2021.05.299

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM32602512X