Prescription patterns of pancreatic enzyme replacement therapy for patients with pancreatic cancer in the United States

Jain, Tejeshwar; Sharma, Prateek; Giri, Bhuwan; Iyer, S.; Sethi, Vrishketan; Bava, Ejas Palathingal; Vaish, Utpreksha; Sahay, Preeti; Datta, Jashodeep; Reddy, Sushanth; Rose, J. Bart; Khan, Anam; Merchant, Nipun B.; Chari, Suresh T.; Dudeja, Vikas

doi:10.1016/j.hpb.2022.05.003

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Previous studies have shown that in high volume pancreatic cancer centers pancreatic enzymes are prescribed more frequently, and probably more adequately, compared to low volume centers 38 .…”

Section: Discussionmentioning

confidence: 97%

Pancreatic Enzyme Replacement Therapy After Pancreatoduodenectomy: Are Patients Treated Adequately? A Systematic Review Correlated with a Prospective Cohort

Bosch

Blank

Straatman

et al. 2023

MRAJ

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Background: Treatment with pancreatic enzymes is necessary to improve nutrient digestion and to prevent malabsorption and deficiencies in patients with exocrine pancreatic insufficiency (EPI) after pancreatoduodenectomy. Aim of this study was to identify the optimal dosage of pancreatic enzymes in patients with EPI after pancreatoduodenectomy and to evaluate if patients are treated adequately. Methods: A systematic review was performed of PubMed, EMBASE and the Cochrane library. They were searched systematically to identify all randomized controlled trials (RCT) reporting on the effect of treatment with pancreatic enzymes on nutritional parameters after pancreatoduodenectomy. Alongside a prospective observational study was performed, where the administered dosage of pancreatic enzymes (i.e., IU lipase) was evaluated by a questionnaire in patients after pancreatoduodenectomy with EPI (defined as fat malabsorption <85%), and was compared to their dietary fat intake. Endpoints of this study were; (1) the percentage of patients that received an adequate dosage based on the results of the systematic literature study, (2) the ratio between reported dose lipase (IU) and fat intake (g) and reported dose of protease (IU) and protein intake (g). Results: Based on literature (3 RCT’s), an effective dosage of pancreatic enzymes to treat EPI following pancreatoduodenectomy should consists of at least 40.000 IU lipase per main meal, ranging from 40.000 to 75.000 IU. Twenty-nine patients were evaluated, to assess the dosage of pancreatic enzymes in relation to their dietary fat intake. In 70 % of the main meals of these patients the recommended dosage (minimum 40.000 IU lipase) was administered. The lowest ratio of the IU lipase per gram dietary fat intake (2.521 ± 1.770 IU/gram fat) was seen at dinners, the highest ratio was observed for breakfasts (4.441 ± 6.936 IU/gram fat). Conclusion: According to the cut-off of minimal 40.000 IU lipase per main meal, the majority of these patients are using an adequate dosage of pancreatic enzymes. The variability between the ratios of the reported dose lipase (IU) and fat intake (g) fat intake per main meals is large and prescribing doses enzymes tailored per fat intake seems more appropriate.

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Section: Discussionmentioning

confidence: 97%

Pancreatic Enzyme Replacement Therapy After Pancreatoduodenectomy: Are Patients Treated Adequately? A Systematic Review Correlated with a Prospective Cohort

Bosch

Blank

Straatman

et al. 2023

MRAJ

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“…Despite these reports, several randomized controlled trials fail to support these findings 34 . Indeed, a recent survey of surgical oncologists suggests that most prescribe PERT as part of multimodality treatment of PDAC, although <20% believe this has an effect on overall survival 35 . Until additional studies are available, PERT should be used to improve nutrition status for individuals with PDAC and EPI, but it is not indicated for a direct survival benefit for all individuals with PDAC.…”

Section: Clinical Features Of Pdacmentioning

confidence: 99%

Fat malabsorption in pancreatic cancer: Pathophysiology and management

Murray,

Ramsey,

Hart

et al. 2024

Nut in Clin Prac

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Exocrine pancreatic insufficiency (EPI) is common in pancreatic ductal adenocarcinoma (PDAC) and may lead to significant nutrition compromise. In the setting of cancer cachexia and gastrointestinal toxicities of cancer treatments, untreated (or undertreated) EPI exacerbates weight loss, sarcopenia, micronutrient deficiencies, and malnutrition. Together, these complications contribute to poor tolerance of oncologic therapies and negatively impact survival. Treatment of EPI in PDAC involves the addition of pancreatic enzyme replacement therapy, with titration to improve gastrointestinal symptoms. Medical nutrition therapies may also be applicable and may include fat‐soluble vitamin replacement, medium‐chain triglycerides, and, in some cases, enteral nutrition. Optimizing nutrition status is an important adjunct treatment approach to improve quality of life and may also improve overall survival.

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“…The literature suggests variations in how PERT is prescribed by clinicians, particularly related to the dosage and timing [16]. Education of patients regarding PERT appears inconsistent and inadequate, which may contribute to poor compliance rates [17]. Lack of awareness regarding PERT and the correct administration may lead to poor quality of life and potentially reduced survival rates in people with pancreatic cancer [10].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: a cross-sectional survey study

Landers,

Brown,

Al Ruheili

et al. 2024

Support Care Cancer

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Purpose This study investigated pancreatic enzyme replacement therapy (PERT) use in people diagnosed with pancreatic cancer in New Zealand (NZ) and Australia (AU). Methods A cross-sectional survey study was conducted using a mixed-media campaign to recruit people with pancreatic cancer and collect information about current PERT use. The questionnaire gathered data on participant demographics, awareness of PERT, prescribing practices and efficacy of enzyme replacement. Results Over 300 people with pancreatic cancer were recruited, 135 from New Zealand and 199 from Australia. Every region, state and territory was represented except for the West Coast (NZ) and the Northern Territory (AU), the lowest populated areas in both countries. In New Zealand, 60% of participants had heard about PERT, compared to 69.3% in Australia. Dosing regimens were inconsistent in both countries, with 18% and 27% of participants being prescribed PERT considered best practice in New Zealand and Australia, respectively. Before PERT commencement, 70% of participants experienced symptoms of malabsorption, with all symptoms improving after therapy was established. The majority of participants were compliant with their medication. Conclusion PERT use in pancreatic cancer in New Zealand and Australia was highly variable and not compliant with international guidelines in which PERT is recommended as standard therapy. Enzyme replacement is effective for improving the symptoms of malabsorption in patients with pancreatic cancer. Clinician education may be needed to help improve the use of PERT in people with pancreatic cancer.

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Prescription patterns of pancreatic enzyme replacement therapy for patients with pancreatic cancer in the United States

Cited by 7 publications

References 27 publications

Pancreatic Enzyme Replacement Therapy After Pancreatoduodenectomy: Are Patients Treated Adequately? A Systematic Review Correlated with a Prospective Cohort

Pancreatic Enzyme Replacement Therapy After Pancreatoduodenectomy: Are Patients Treated Adequately? A Systematic Review Correlated with a Prospective Cohort

Fat malabsorption in pancreatic cancer: Pathophysiology and management

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: a cross-sectional survey study

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