Pancreatic cancer

The prevalence of PEI in patients with pancreatic cancer is 80–90%, and both the site and degree of ductal obstruction will determine the severity of PEI in these patients.1 In pancreatic cancer, pancreatic enzyme insufficiency commonly occurs through either obstruction of the pancreatic duct by tumours of the head of the pancreas or through the loss of functioning pancreatic parenchyma by progressive destruction with tumour growth. Loss of pancreatic tissue following surgical procedures also contributes to pancreatic enzyme insufficiency.1-3

The resulting malabsorption is associated with bodyweight loss and malnutrition, which are in turn associated with a poor prognosis, increased morbidity and delayed recovery following surgery, significant reduction in quality of life and even interruption of cancer therapy.2

Malabsorption and weight loss in these patients are often overlooked. Most patients with cancer of the pancreatic head region are already exocrine insufficient at diagnosis. Given this high prevalence, physicians should direct their focus to diagnose and treat exocrine insufficiency with pancreatic enzymes to optimize the patient’s nutritional status and physical condition, maintain weight, endure surgery, improve tolerance to palliative chemotherapy and/or radiotherapy and increase their quality of life.4,5

Pancreatic enzyme supplementation should be considered in most patients with pancreatic cancer and used whenever there is clinical suspicion of exocrine insufficiency.2

Patients with pancreatic cancer struggle with symptoms of malabsorption, unaware that they could be helped with medication, with a negative impact on both their physical and psychological health.6

Retrospective analysis of a prospective database of 66 patients (mean age 69.3) with unresectable pancreatic cancer confirmed by EUS-FNB. Patients with survival < 30 days were excluded. All patients were evaluated for palliative chemotherapy. Patients diagnosed in Department of Gastroenterology (Group 1; 31.8%) were also evaluated for PEI by 13C-MTG breath test and nutritional status; patients in Group 2 (68.2%) were not. Group 1 patients with PEI were treated with Creon 50,000 lipase units/meal and 25,000 lipase units/snack.

References

  1. Keller J et al. Gut 2005; 54(Suppl6): 1-28.
  2. Imrie CW et al. Aliment Pharmacol Ther 2010; 32(Suppl. 1): 1–25
  3. Friess H et al. Digestion 1993; 54(Suppl 2): 48–53
  4. Sikkens ECM et al. J Clin Gastroenterol 2014; 48: e43–e46
  5. Guidelines for the management of patients with pancreatic, periampullary and ampullary carcinomas. Gut 2005; 54(suppl 5): v1–v16
  6. Gooden HM. Support Care Cancer 2013; 21(7): 1835-41.

"Well the pancreatic enzyme [Creon] made such a huge difference. If we’d only known we could have got that earlier. That would have been great."

Male carer of a pancreatic cancer patient (bereaved)6

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