175P The effect of pancreatic enzyme replacement therapy on the gut microbiome and immune response of patients with pancreatic ductal adenocarcinoma associated pancreatic enzyme insufficiency

distress (NCCN Distress Thermometer with problem list), and quality of life (EORTC QLQ-C30).Malnutrition was defined using age-adapted BMI thresholds (18.5 kg/m 2 for patients <70 years and <21 kg/m 2 for patients 70 years) or unintentional weight loss (10% from usual or 6-month body weight).Data on pre-existing SC were collected.The primary endpoint was the rate of SC referrals.Results: Thirty-nine patients were included (25 female, 14 male); median age was 56 years (IQR 50-63), with a median of one prior treatment line (range 0-7).The most frequent tumor types were head and neck (n=10), breast (n=8), and sarcoma (n=5).Malnutrition was present in 32.4% of patients, with an additional 25.6% at risk (SEFI 7).Severe pain (VAS 7) affected nearly one-third of both women and men, significant distress (DT 4) was observed in 57% of patients, and fatigue was the most common symptom (87.2%).Mobility impairment was reported only by women (37.5%, Fisher's exact test p<0.05).Clinicians underestimated patient-reported performance status in 41.7% of cases.More than half of patients (58,9%) required or were already receiving SC.SC referrals were recommended in 33% of pts, more frequently in men than in women (50% vs 24%), mainly for psychological support and pain management (15% and 10%, respectively).Conclusions: Systematic supportive care assessment at EPCT screening was feasible and identified supportive care needs in approximately one third of patients.These findings support further research on the integration of systematic supportive care assessment within EPCT workflows.