Abstract Background Exocrine pancreatic insufficiency (EPI), a common complication of pancreatic cancer (PC), reduces quality of life and may shorten survival. While pancreatic enzyme replacement therapy (PERT) improves symptoms and outcomes, real-world patterns of EPI workup and PERT use across PC subtypes remain poorly described in the US. Patients and Methods We retrospectively analyzed 250 patients with resectable or metastatic PC from a single institution’s prospectively maintained registry (2013–2018), collecting data on clinical characteristics, EPI symptoms, fecal elastase testing, and PERT prescriptions. In addition to the retrospective analysis, a quality improvement intervention for EPI management was implemented (1/2021–1/2023) and outcomes were analyzed. Results Among 250 patients, 97 underwent surgery for resectable disease and 153 received non-surgical management for metastatic PC. EPI symptoms occurred in 58% of metastatic and 68% of surgical patients. Fecal elastase testing was rarely performed (2% vs. 9%, respectively). PERT was prescribed to 46.5% of metastatic and 84% of surgical patients, but average doses were suboptimal (18,500 vs. 20,000 USP units per meal; recommended: ≥40,000). Among those on PERT, symptom resolution was reported in 33% of metastatic and 44% of surgical patients. Contrasting with results from the retrospective analysis, the quality improvement intervention led to 90% of 41 participants being prescribed PERT at an average dose of 44,700 USP units per meal. 74.1% of treated patients experienced complete resolution of EPI symptoms. Conclusion Despite prevalent EPI symptoms in PC patients, fecal elastase testing was infrequently utilized, and PERT was often underdosed. Educational initiatives are needed to improve guideline adherence and optimize outcomes.
Ni et al. (Fri,) studied this question.
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