Introduction Pancreatic enzyme insufficiency (PEI) is a well-recognised cause of malnutrition in pancreatic cancer (PC). Pancreatic enzyme replacement therapy (PERT) in the form of enteric coated pancreatin microspheres is recommended in these patients with symptoms of PEI to prevent weight loss and malnutrition and improve quality of life. Given that the probability of PEI is high in PC (80–90%), PERT is recommended without the use of formal diagnostic tests. The optimal starting dose of PERT is 40–50000 lipase units per main meal. The aim of this study was to evaluate the use of PERT in PC patients, to ascertain if these patients were given the appropriate PERT dose and to determine whether dietician review was associated with more and better PERT use.
Method A single centre retrospective analysis of patients diagnosed with PC in 2014 in a tertiary hospital specialising in the treatment of patients with hepato-pancreato-biliary (HPB) diseases. We identified 80 patients with PC. Information was collected from electronic patient records regarding the patients’ symptoms of PEI, evidence of PERT use, the dose prescribed and whether the patients were seen by a dietician. Fisher’s exact test was used to calculate whether (a) dietician review was associated with higher rate of PERT use and (b) dietician review was associated with higher rate of appropriate PERT dosing.
Results Symptoms of PEI (abdominal pain, weight loss or steatorrhoea) were recorded in 57.5% of PC patients (46/80). PERT was prescribed in the minority of patients [41.3% (33/80)] with appropriate dosing given to the majority of patients when prescribed [66.7% (22/33)]. A dietician was involved in the care of less than half [43.8% (35/80)] of patients. However, referral to a dietician was strongly associated with PERT use with 60% (21/35) of patients being referred given PERT compared to only 26.7% (12/45) of patients who were not (p = 0.003). Dietician involvement was also associated with more appropriate PERT use with 85% (17/20) of patients given appropriate doses compared to 45.5% (5/11); (p = 0.038) when started without dietician review.
Conclusion In this audit, we demonstrated that while symptoms of PEI were present in the majority of patients, the minority of patients were given PERT. The minority of patients were seen by a dietician but when assessed were more likely to receive PERT at the appropriate dosage, which may account for the low rate of PERT in the cohort as a whole. This study highlights the lack of awareness of the problem of PEI in PC patients amongst managing physicians. This could lead to a missed opportunity to reduce symptoms and improve quality of life in patients with a simple intervention. A referral to the dietician was shown to benefit these patients.
Disclosure of interest None Declared.