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Research Article

Cancer Research Frontiers. 2016 Sept; 2(3): 352-367. doi: 10.17980/2016.352

Prevalence of symptomatic pancreatic exocrine insufficiency in patients with pancreatic malignancy: nutritional intervention may improve survival.

Lynne McCallum1*Δ, Angela Lamarca1*, Juan W Valle1,2

1 Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, Manchester, United Kingdom

2 Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, Manchester, United Kingdom

*Lynne McCallum and Angela Lamarca contributed equally to this work.

 

Δ Corresponding author: Lynne McCallum, Medical Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, UK. Telephone: +44 (0)1614468106; Fax number: +44 (0)1614463468. Email: Lynne.McCallum@christie.nhs.uk.

Citation: Lynne McCallum, et al. Prevalence of symptomatic pancreatic exocrine insufficiency in patients with pancreatic malignancy: nutritional intervention may improve survival. Cancer Research Frontiers. 2016 Sept; 2(3): 352-367. doi: 10.17980/2016.352

Copyright: @ 2016 Lynne McCallum, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The authors declare no competing financial interests.

Received June 11, 2016; Revised July 25, 2016; Accepted Aug 5, 2016. Published Sept 16, 2016

 

ABSTRACT

Patients diagnosed with pancreatic cancer (PC) will often present with symptoms affecting their nutritional wellbeing. We aimed to assess the nutritional support provided to patients with PC in an oncology reference centre. We undertook a single-centre retrospective analysis of all consecutive patients (Jan’13 – Jan’14) diagnosed with PC [both pancreatic ductal adenocarcinoma (PDAC) and neuroendocrine tumours (pNETs) were included]. The primary end-point was to assess the prevalence of pancreatic exocrine insufficiency (PEI)-related symptoms/signs and the nutritional support provided. Secondary objectives included analysis of the impact of nutritional intervention on overall survival (OS). A total of 183 patients were eligible; most (78%) of the patients were diagnosed with PDAC and had been referred for palliative chemotherapy (83%). Sixty-three percent of patients (n=115) had symptoms/signs in keeping with PEI (weight loss, abdominal pain and / or diarrhoea). Seventy-nine patients (43%) received nutritional intervention defined as pancreatic enzyme replacement therapy (PERT) (93%), nutritional supplements (4%) or referral to a dietician (4%). Patients who received a nutritional intervention were more likely to receive chemotherapy treatment (65.8% vs. 50%; p-value 0.03). Nutritional intervention was shown to be an independent factor associated with longer survival (10.2 months (95% Confidence Interval (CI) 7.5-13.3) vs. 6.9 months (95% CI 5.5-9.9); Hazard Ratio (HR) 0.6 (95% CI 0.4-0.9), p-value 0.015) when adjusted for other variables in a multivariable analysis. Our data highlight the importance of nutritional assessment and support to all patients diagnosed with PC, particularly due to its potential impact on ability to deliver chemotherapy and its effect on survival.

Keywords: pancreatic cancer, nutrition, pancreatic exocrine insufficiency, pancreatic exocrine replacement therapy, chemotherapy, overall survival

 

 

 

 

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