Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study

Roberts, Keith; Bannister, Christian; Schrem, Harald

doi:10.1016/j.pan.2018.10.010

Cited by 95 publications

(99 citation statements)

References 31 publications

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“…These low rates of PERT use are similar to survey reports from Europe 24‐26 . There are a number of potential explanations.…”

Section: Discussionsupporting

confidence: 80%

“…One retrospective study suggested exocrine pancreatic insufficiency was associated with reduced survival in patients with chronic pancreatitis 39 . A number of cohort studies, 22,40,41 a population‐based cohort study, 26 and some small randomised trials 42,43 have assessed the benefit of PERT in patients with pancreatic cancer. While results are not uniform, the largest population‐based analysis 26 demonstrates significantly improved survival (adjusted survival 2.62‐fold greater than those not on PERT [95% CI 2.27‐3.02]).…”

Section: Discussionmentioning

confidence: 99%

“…A number of cohort studies, 22,40,41 a population‐based cohort study, 26 and some small randomised trials 42,43 have assessed the benefit of PERT in patients with pancreatic cancer. While results are not uniform, the largest population‐based analysis 26 demonstrates significantly improved survival (adjusted survival 2.62‐fold greater than those not on PERT [95% CI 2.27‐3.02]). Certainly, practice guidelines for chronic pancreatitis recommend testing for exocrine pancreatic insufficiency and treating if identified 44,45 .…”

Section: Discussionmentioning

confidence: 99%

“…It may not be necessary to supplement with 90 000 USP units of lipase with each meal, as there may be residual pancreatic secretion, and gastric lipase may partially compensate for reductions in pancreatic lipase. A typical starting dose would be 40 000‐50 000 USP units with each meal, 15 but several European survey studies show many patients receive far less 24,25 or do not receive PERT at all 26 . No systematic analysis of the use of PERT for patients with chronic pancreatitis or pancreatic cancer has been performed in the US, so we attempted to estimate the frequency of appropriate use of PERT in an insured population in the US.…”

Section: Introductionmentioning

confidence: 99%

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The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

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“…These low rates of PERT use are similar to survey reports from Europe 24‐26 . There are a number of potential explanations.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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“…Several other studies have shown the benefits of PERT in patients with advanced PC, mostly in terms of weight gain [50,51,53] or even OS [53,55]. In addition, QoL is improved in patients receiving PERT [54], together with symptoms such as pancreatic and hepatic pain and diarrhoea.…”

Section: Maldigestion and Treatment In Unresectable And Metastatic Pamentioning

confidence: 95%

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

Pezzilli

Caccialanza

Capurso

et al. 2020

Cancers

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Pancreatic cancer is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries. More than 80% of patients suffer from significant weight loss at diagnosis and over time tend to develop severe cachexia. A major cause of weight loss is malnutrition. Patients may experience pancreatic exocrine insufficiency (PEI) before diagnosis, during nonsurgical treatment, and/or following surgery. PEI is difficult to diagnose because testing is cumbersome. Consequently, PEI is often detected clinically, especially in non-specialised centres, and treated empirically. In this position paper, we review the current literature on nutritional support and pancreatic enzyme replacement therapy (PERT) in patients with operable and non-operable pancreatic cancer. To increase awareness on the importance of PERT in pancreatic patients, we provide recommendations based on literature evidence, and when data were lacking, based on our own clinical experience.

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Management of Pain in Pancreatic Cancer

Domínguez‐Muñoz¹

2021

Clinical Pancreatology for Practising Gastroenterologists and Surgeons

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Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study

Cited by 95 publications

References 31 publications

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

Management of Pain in Pancreatic Cancer

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