@article{034bbf31a545433f9d12921b497d584e,
title = "Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study",
abstract = "Objective: UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates. Design: RICOCHET was a national prospective audit of malignant pancreatic, peri-ampullary lesions or malignant biliary obstruction between April and August 2018. This analysis focuses on pancreatic cancer patients and is reported to STROBE guidelines. Multivariable regression analysis was undertaken to assess factors associated with PERT prescribing. Results: Rates of PERT prescribing varied among the 1350 patients included. 74.4% of patients with potentially resectable disease were prescribed PERT compared to 45.3% with unresectable disease. PERT prescription varied across surgical hospitals but high prescribing rates did not disseminate out to the respective referring network. PERT prescription appeared to be related to the treatment aim for the patient and the amount of clinician contact a patient has. PERT prescription in potentially resectable patients was positively associated with dietitian referral (p = 0.001) and management at hepaticopancreaticobiliary (p = 0.049) or pancreatic unit (p = 0.009). Prescription in unresectable patients also had a negative association with Charlson comorbidity score 5–7 (p = 0.045) or >7 (p = 0.010) and a positive association with clinical nurse specialist review (p = 0.028). Conclusion: Despite national guidance, wide variation and under-treatment with PERT exists. Given that most patients with pancreatic cancer have unresectable disease and are treated in non-surgical hospitals, where prescribing is lowest, strategies to disseminate best practice and overcome barriers to prescribing are urgently required.",
keywords = "Dietitian, Enzyme replacement, Pancreas, Pancreatic cancer, Pancreatic resection",
author = "{Steering Committee} and {Regional Leads} and {Local Teams} and {The RICOCHET Study Group on behalf of the West Midlands Research Collaborative, Writing Group} and Harvey, {P. R.} and McKay, {S. C.} and Wilkin, {R. J.W.} and Layton, {G. R.} and S. Powell-Brett and K. Okoth and N. Trudgill and Roberts, {K. J.} and G. Baker and Brom, {M. K.} and Z. Brown and A. Farrugia and D. Haldar and M. Kalisvaart and A. Marley and R. Pande and R. Patel and Stephenson, {B. T.F.} and C. Baillie and C. Croitoru and Eddowes, {P. J.} and M. Elshaer and Farhan-Alanie, {M. M.} and R. Laing and K. Mann and L. Materacki and S. Nandi and S. Pericleous and P. Prasad and S. Rinkoff and E. Selvaraj and J. Shah and Sheel, {A. R.G.} and P. Szatmary and P. Williams and J. Milburn and M. Bekheit and M. Ghazanfar and H. Curry and P. Persson and A. Rollo and R. Thomson and S. Harper and S. Varghese and J. Collins and W. Stupalkowska and Z. Afzal and A. Badran and J. Barker and A. Hakeem and R. Kader and S. Saji and S. Sheikh and Smith, {A. C. D.} and K. Stasinos and H. Steinitz and H. Malik and C. Burston and L. Carrion-Alvarez and M. Shiwani and G. Ahmad and T. Allen and E. Darley and S. Patil and C. Brooks and B. Cresswell and F. Welsh and C. Cook and R. Smyth and R. Booth and M. West and A. King and O. Tucker and L. Phelan and A. Burahee and C. Devogel and A. Javed and R. Kay and S. Khan and F. Leet and T. Troth and A. Ward and J. Young and E. Murray and T. Gray and R. Johnson and S. Lockwood and R. Young and G. Zhou and J. Portal and J. Rees and B. Arnold and D. Scroggie and Abeysekera, {K. W.M.} and A. Asif and F. Hay and T. Maccabe and S. Pathak and H. Robertson and C. Sandberg and H. Woodland and A. Charalabopoulos and A. Kordzadeh and J. Anderson and D. Napier and P. Hodges and G. Jones and G. Sheiybani and T. Archer and A. Khan and S. Kirk and N. Walker and U. Hassam and I. Wong and M. Silva and K. Jones and J. Allen and Abbas, {S. H.} and M. Harborne and Z. Majid and N. Eardley and I. Reilly and P. Wadsworth and C. Bell and K. Holloway and W. Stockton and R. Thomas and Williams, {K. J.} and R. Canelo and Y. Tay and M. Adnan and S. Aroori and N. Rajaretnam and S. Rekhraj and A. Wilkins and R. Nelapatia and M. Verebcean and S. Braithwaite and J. Apollos and N. Robertson and A. Belgaumkar and A. Brant and A. Shahdoost and French, {J. J.} and G. Sen and R. Thakkar and A. Kanwar and J. Klaptocz and P. Rodham and B. O'Riordan and G. Maharaj and M. Davies and S. Higgs and J. Cutting and M. Joseph and L. Backhouse and J. Butler and J. Cooper and T. O'nions and S. Shaukat and A. Kumar and V. George and J. Ingmire and A. Saha and P. Coe and R. Noor and P. Lykoudis and A. Elshaer and A. Andreou and T. Clarke and O. Davies and P. Rimmer and V. Kanakala and V. Mitra and G. Akol and M. Burgess and M. Elzubier and R. Jones and D. Majumdar and H. Wescott and A. Bailey and M. Gomez and O. Herman and J. Deguara and T. Whitehead-Clarke and L. Gorard and R. Law and Leung, {L. Y.} and D. Whitelaw and M. Adil and S. Krivan and J. Waters and R. Fernandes and L. Mealey and R. Merh and A. Okaro and J. Shepherd and D. O'Reilly and J. Pilkington and Z. Hussain and S. Ingram and Stott, {M. C.} and S. Abbott and N. Bhamra and F. Hirri and K. Lee and J. Murrell and S. Resool and M. Taylor and M. King and R. Madhotra and H. Ayubi and J. Ali and N. Chander and G. Mckune and T. Wothers and G. Shingler and M. Mortimer and K. Dykes and H. Edwards and S. Menon and A. Gautham and I. Ali and R. Anjum and M. Brookes and B. Wilkinson and I. Tait and I. Noaman and M. Wilson and S. Mogan and S. Rushbrook and S. Hyde and S. Baker and P. Hall and H. Lucas and J. Pease and A. Millar and Z. Tariq and W. Blad and M. Cunningham and M. Hall and P. Luthra and K. Seymour and Y. Aawsaj and M. Jones and D. Elliott and Finch, {J. G.} and Y. Rajjoub and A. Gupta and P. Molloy and I. Mykoniatis and E. Atallah and E. Albraba and V. Asimba and A. Baxter and A. Chin and K. Vojtekova and L. Ong and Modi, {H. N.} and F. Muscara and M. Perry and C. Katz and N. Shaban and L. Dichmont and T. Dissanayake and W. Mostafa and D. Ghosh and S. Hwang and O. Bajomo and T. Lloyd and J. Wye and A. Holt and A. Pathanki and S. Townsend and N. Babar and F. Giovinazzo and L. Kennedy and M. Kandathil and D. King and M. Pillai and P. Glen and D. Holroyd and S. Drozdzik and G. Kourounis and J. Thompson and S. McNally and I. Thomas and Y. Reddy and D. Subar and N. Heywood and E. Khoo and A. Austin and A. Awan and H. Tan and M. Kasi and S. Prasad and M. Baqai and {Abd Alkoddus}, M. and O. Al-Allaf and K. Mitchell and S. Mole and A. Yoong and G. Fusai and S. Brown and S. Bulathsinhala and J. Gilliland and T. Boyce and M. Al-Ardah and E. Matthews and C. Wakefield and D. Hou and S. Thomasset and R. Guest and S. Falconer and M. Hughes and C. Johnston and Kung, {J. W.C.} and E. Lee and E. McNally and Sherif, {A. E.} and B. Stutchfield and Baron, {R. D.} and Dunne, {D. F.J.} and Dickerson, {L. D.} and Exarchou, {K. E.} and E. Knight and P. Whelan and R. Hutchins and P. Wilson and S. Phillpotts and F. Badrulhisham and A. Dawes and Y. Derwa and S. Rajagopal and S. Ramoutar and T. Vaik and Bhogal, {R. H.} and N. McLaren and T. Policastro and J. Butterworth and M. Riera and A. Ismail and A. Ahmed and R. Alame and K. Alford and S. Banerjee and C. Bull and G. Kirby and T. Athwal and S. Hebbar and J. Ishtiaq and U. Kamran and A. Abbasi and M. Kamarul-bahrin and A. Banks and A. Khalil and N. Karanjia and D. Trivedi and S. Chakravaratty and A. Frampton and J. Gabriella and G. Pinn and B. Colleypriest and F. Betteridge and D. Murugiah and A. Rossiter and K. Yong and C. Sellahewa and K. Chui and A. Ehsan and N. Fisher and S. Iyer and H. McMurtry and G. Garbutt and S. Mahgoub and L. Alleyne and J. Harvey and K. Johnson and E. Richards and N. Palaniyappan and C. Bowler and R. Inumerable and M. Abu and A. Suhool and T. Talbot and J. Westwood and G. Zumbo and A. Osborne and A. Botes and S. Dyer and I. Thomas-Jones and L. Merker and R. Przemioslo and M. Roderick and J. Valverde and A. Zerafa and S. Barker and A. Wan and R. Lalani and C. Barrett and N. Kapirial and K. McCarthney and R. Ramamoorthy and M. Yalchin and M. Huggett and C. Macutkiewicz and Smith, {A. C.D.} and A. Buchanan and J. Burke and G. Goodchild and Keane, {M. G.} and J. Potts and B. Disney and M. McFarlane and E. Baker and S. Bullock and S. Coleman and C. Mcardle and J. Morgan and E. Mozdiak and A. Obisesan and L. O'Flynn and N. Mowbray and {de Berker}, {H. T.} and P. Driscoll and Alberts, {J. C.} and Sadien, {I. D.} and K. Webb and H. Khalil and C. Parmar and D. Sadigh and P. Seyed-Safi and L. Shala and M. Somasundaram and G. Bryce and K. McCormack and W. Jamieson and L. Mitchell and D. Cheung and B. Hicken and N. Abbas and A. Kurian and I. Tahir and J. Spearman and T. Johnston and C. Jones",
note = "Publisher Copyright: {\textcopyright} 2021 IAP and EPC",
year = "2021",
month = sep,
day = "10",
doi = "10.1016/j.pan.2021.05.299",
language = "English",
volume = "21",
pages = "1127--1134",
journal = "Pancreatology",
issn = "1424-3903",
publisher = "Elsevier",
number = "6",
}