PTU-70 Pancreatic Enzyme Replacement in Unresectable Pancreatic Cancer: A retrospective study from a district general hospital
IntroductionAdvanced pancreatic cancer has a poor prognosis and is associated with pancreatic exocrine insufficiency (PEI) causing weight loss and cachexia. Pancreatic enzyme replacement therapy (PERT) is recommended by the National Institute for Health and Care Excellence (NICE) for patients with u...
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| Veröffentlicht in: | Gut 2021-11, Vol.70 (Suppl 4), p.A146-A147 |
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| description | IntroductionAdvanced pancreatic cancer has a poor prognosis and is associated with pancreatic exocrine insufficiency (PEI) causing weight loss and cachexia. Pancreatic enzyme replacement therapy (PERT) is recommended by the National Institute for Health and Care Excellence (NICE) for patients with unresectable pancreatic cancer but is often not prescribed despite evidence it can improve quality of life and survival. The aim of this retrospective study was to assess adherence to the NICE recommendations on the use of PERT and its impact on patient survival.MethodsPatients with a radiological or histological diagnosis of unresectable pancreatic cancer were identified from a retrospective cancer multidisciplinary team database in a district general hospital from January 2017 to August 2019. Patient demographics and survival from time of diagnosis were compared for patients treated with and without PERT. T-tests and Chi-squared tests were used as appropriate.Results166 patients diagnosed with unresectable pancreatic cancer were identified, 80 (48%) were treated with PERT. Median age was 75 years in the PERT group versus 79 years in the no PERT group (p=.014).The PERT group were more likely to have better performance status (performance status ≥3, 33% vs 56% (p=0.024), less likely to have advanced disease (stage ≥3, 33% vs 56% (p=.0017) and were more likely to receive chemotherapy (33 patients vs 12 patients, p |
| doi_str_mv | 10.1136/gutjnl-2021-BSG.272 |
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Pancreatic enzyme replacement therapy (PERT) is recommended by the National Institute for Health and Care Excellence (NICE) for patients with unresectable pancreatic cancer but is often not prescribed despite evidence it can improve quality of life and survival. The aim of this retrospective study was to assess adherence to the NICE recommendations on the use of PERT and its impact on patient survival.MethodsPatients with a radiological or histological diagnosis of unresectable pancreatic cancer were identified from a retrospective cancer multidisciplinary team database in a district general hospital from January 2017 to August 2019. Patient demographics and survival from time of diagnosis were compared for patients treated with and without PERT. T-tests and Chi-squared tests were used as appropriate.Results166 patients diagnosed with unresectable pancreatic cancer were identified, 80 (48%) were treated with PERT. Median age was 75 years in the PERT group versus 79 years in the no PERT group (p=.014).The PERT group were more likely to have better performance status (performance status ≥3, 33% vs 56% (p=0.024), less likely to have advanced disease (stage ≥3, 33% vs 56% (p=.0017) and were more likely to receive chemotherapy (33 patients vs 12 patients, p<.001) compared to the no PERT group. The PERT group had longer survival times (median survival 151 days vs 46 days, p<.001, figure 1).There was increased survival for patients treated with PERT when patients treated with chemotherapy were excluded (median survival of 98 days vs 37 days, p=.004). Additionally, there was increased survival for those treated with PERT and chemotherapy compared to those treated with chemotherapy without PERT (226 days vs 101 days, p=.04).Sub-group analysis demonstrated statistically significant increased survival for patients treated with PERT with cancer of the pancreatic head (median survival of 165 days vs 44 days, p=.001) and of the pancreatic body (median survival of 174 days vs 37 days, p=.001).Abstract PTU-70 Figure 1ConclusionsThis retrospective, pragmatic study of patients diagnosed with unresectable pancreatic cancer showed that less than half of patients were treated with PERT. PERT was associated with a clinically significant (approximately 3-fold) increase in survival regardless of whether chemotherapy was given. However, these results are likely to be confounded by selection bias given the higher percentage of patients in the no PERT group with more advanced disease and poorer performance status. We recommend offering all patients diagnosed with unresectable pancreatic cancer PERT.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gutjnl-2021-BSG.272</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Body weight loss ; Cachexia ; Chemotherapy ; Demography ; Diagnosis ; Enzymes ; Medical prognosis ; Pancreatic cancer ; Patients ; Quality of life ; Statistical analysis ; Survival</subject><ispartof>Gut, 2021-11, Vol.70 (Suppl 4), p.A146-A147</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids></links><search><creatorcontrib>Keen, Timothy</creatorcontrib><creatorcontrib>Zhao, Melissa</creatorcontrib><creatorcontrib>Chan, Keith</creatorcontrib><creatorcontrib>Ayres, Lachlan</creatorcontrib><title>PTU-70 Pancreatic Enzyme Replacement in Unresectable Pancreatic Cancer: A retrospective study from a district general hospital</title><title>Gut</title><addtitle>Gut</addtitle><description>IntroductionAdvanced pancreatic cancer has a poor prognosis and is associated with pancreatic exocrine insufficiency (PEI) causing weight loss and cachexia. Pancreatic enzyme replacement therapy (PERT) is recommended by the National Institute for Health and Care Excellence (NICE) for patients with unresectable pancreatic cancer but is often not prescribed despite evidence it can improve quality of life and survival. The aim of this retrospective study was to assess adherence to the NICE recommendations on the use of PERT and its impact on patient survival.MethodsPatients with a radiological or histological diagnosis of unresectable pancreatic cancer were identified from a retrospective cancer multidisciplinary team database in a district general hospital from January 2017 to August 2019. Patient demographics and survival from time of diagnosis were compared for patients treated with and without PERT. T-tests and Chi-squared tests were used as appropriate.Results166 patients diagnosed with unresectable pancreatic cancer were identified, 80 (48%) were treated with PERT. Median age was 75 years in the PERT group versus 79 years in the no PERT group (p=.014).The PERT group were more likely to have better performance status (performance status ≥3, 33% vs 56% (p=0.024), less likely to have advanced disease (stage ≥3, 33% vs 56% (p=.0017) and were more likely to receive chemotherapy (33 patients vs 12 patients, p<.001) compared to the no PERT group. The PERT group had longer survival times (median survival 151 days vs 46 days, p<.001, figure 1).There was increased survival for patients treated with PERT when patients treated with chemotherapy were excluded (median survival of 98 days vs 37 days, p=.004). Additionally, there was increased survival for those treated with PERT and chemotherapy compared to those treated with chemotherapy without PERT (226 days vs 101 days, p=.04).Sub-group analysis demonstrated statistically significant increased survival for patients treated with PERT with cancer of the pancreatic head (median survival of 165 days vs 44 days, p=.001) and of the pancreatic body (median survival of 174 days vs 37 days, p=.001).Abstract PTU-70 Figure 1ConclusionsThis retrospective, pragmatic study of patients diagnosed with unresectable pancreatic cancer showed that less than half of patients were treated with PERT. PERT was associated with a clinically significant (approximately 3-fold) increase in survival regardless of whether chemotherapy was given. However, these results are likely to be confounded by selection bias given the higher percentage of patients in the no PERT group with more advanced disease and poorer performance status. We recommend offering all patients diagnosed with unresectable pancreatic cancer PERT.</description><subject>Body weight loss</subject><subject>Cachexia</subject><subject>Chemotherapy</subject><subject>Demography</subject><subject>Diagnosis</subject><subject>Enzymes</subject><subject>Medical prognosis</subject><subject>Pancreatic cancer</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Statistical analysis</subject><subject>Survival</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNpN0MtKAzEUgOEgCtbqE7gJuI7NZWaScVdLrULBou16yExO6gxzqZlUqKtufFGfxJQKuspZfJxDfoSuGb1lTCSj9dZXbU045Yzcv85uueQnaMCiRBHBlTpFA0qZJLGM0nN00fcVpVSplA3QfrFcEUm_918L3RYOtC8LPG0_dw3gF9jUuoAGWo_LFq9aBz0UXuc14H96EkZwd3iMHXjX9Ztgyg_Avd-aHbaua7DGpuy9KwuP19CC0zV-C7D0ur5EZ1bXPVz9vkO0epguJ49k_jx7moznJA8_5CQXMrZxwrQCa2KbpJrFiTHcGJoIKzgYIZmmYPIYjJLKSmtEolKt87SQnIkhujnu3bjufQu9z6pu69pwMuNxGok0UiIOanRUeVP9AUazQ-bsmDk7ZM5C5ixkFj-yTHVR</recordid><startdate>20211107</startdate><enddate>20211107</enddate><creator>Keen, Timothy</creator><creator>Zhao, Melissa</creator><creator>Chan, Keith</creator><creator>Ayres, Lachlan</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20211107</creationdate><title>PTU-70 Pancreatic Enzyme Replacement in Unresectable Pancreatic Cancer: A retrospective study from a district general hospital</title><author>Keen, Timothy ; Zhao, Melissa ; Chan, Keith ; Ayres, Lachlan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1132-b375f561a8efd5f69a156dd2dd063f32ed371a0edb5ed878f7fd3689aab9c7213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Body weight loss</topic><topic>Cachexia</topic><topic>Chemotherapy</topic><topic>Demography</topic><topic>Diagnosis</topic><topic>Enzymes</topic><topic>Medical prognosis</topic><topic>Pancreatic cancer</topic><topic>Patients</topic><topic>Quality of life</topic><topic>Statistical analysis</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keen, Timothy</creatorcontrib><creatorcontrib>Zhao, Melissa</creatorcontrib><creatorcontrib>Chan, Keith</creatorcontrib><creatorcontrib>Ayres, Lachlan</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keen, Timothy</au><au>Zhao, Melissa</au><au>Chan, Keith</au><au>Ayres, Lachlan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>PTU-70 Pancreatic Enzyme Replacement in Unresectable Pancreatic Cancer: A retrospective study from a district general hospital</atitle><jtitle>Gut</jtitle><stitle>Gut</stitle><date>2021-11-07</date><risdate>2021</risdate><volume>70</volume><issue>Suppl 4</issue><spage>A146</spage><epage>A147</epage><pages>A146-A147</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><abstract>IntroductionAdvanced pancreatic cancer has a poor prognosis and is associated with pancreatic exocrine insufficiency (PEI) causing weight loss and cachexia. Pancreatic enzyme replacement therapy (PERT) is recommended by the National Institute for Health and Care Excellence (NICE) for patients with unresectable pancreatic cancer but is often not prescribed despite evidence it can improve quality of life and survival. The aim of this retrospective study was to assess adherence to the NICE recommendations on the use of PERT and its impact on patient survival.MethodsPatients with a radiological or histological diagnosis of unresectable pancreatic cancer were identified from a retrospective cancer multidisciplinary team database in a district general hospital from January 2017 to August 2019. Patient demographics and survival from time of diagnosis were compared for patients treated with and without PERT. T-tests and Chi-squared tests were used as appropriate.Results166 patients diagnosed with unresectable pancreatic cancer were identified, 80 (48%) were treated with PERT. Median age was 75 years in the PERT group versus 79 years in the no PERT group (p=.014).The PERT group were more likely to have better performance status (performance status ≥3, 33% vs 56% (p=0.024), less likely to have advanced disease (stage ≥3, 33% vs 56% (p=.0017) and were more likely to receive chemotherapy (33 patients vs 12 patients, p<.001) compared to the no PERT group. The PERT group had longer survival times (median survival 151 days vs 46 days, p<.001, figure 1).There was increased survival for patients treated with PERT when patients treated with chemotherapy were excluded (median survival of 98 days vs 37 days, p=.004). Additionally, there was increased survival for those treated with PERT and chemotherapy compared to those treated with chemotherapy without PERT (226 days vs 101 days, p=.04).Sub-group analysis demonstrated statistically significant increased survival for patients treated with PERT with cancer of the pancreatic head (median survival of 165 days vs 44 days, p=.001) and of the pancreatic body (median survival of 174 days vs 37 days, p=.001).Abstract PTU-70 Figure 1ConclusionsThis retrospective, pragmatic study of patients diagnosed with unresectable pancreatic cancer showed that less than half of patients were treated with PERT. PERT was associated with a clinically significant (approximately 3-fold) increase in survival regardless of whether chemotherapy was given. However, these results are likely to be confounded by selection bias given the higher percentage of patients in the no PERT group with more advanced disease and poorer performance status. We recommend offering all patients diagnosed with unresectable pancreatic cancer PERT.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><doi>10.1136/gutjnl-2021-BSG.272</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Body weight loss Cachexia Chemotherapy Demography Diagnosis Enzymes Medical prognosis Pancreatic cancer Patients Quality of life Statistical analysis Survival |
| title | PTU-70 Pancreatic Enzyme Replacement in Unresectable Pancreatic Cancer: A retrospective study from a district general hospital |
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