# Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study

Source: https://onco.cc/key-papers/paper-roberts-pert-survival-pancreatic-cancer-pancreatology-2019/  
OnCo record `paper-roberts-pert-survival-pancreatic-cancer-pancreatology-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A 2019 study of UK primary care records finding that only about one in five people with pancreatic cancer was prescribed the digestive enzyme capsules that replace what the diseased pancreas no longer makes, and that those who were lived markedly longer.

## Summary

Roberts, Bannister and Schrem identified patients with pancreatic adenocarcinoma in the UK Clinical Practice Research Datalink and used propensity score matching to compare those who did and did not receive pancreatic enzyme replacement therapy. Use across the whole cohort was 21.7 percent (987 of 4,554). From 1,614 subjects, 807 matched pairs gave 1,643 years of censored follow-up and 1,403 deaths; unadjusted mortality was 748 versus 994 deaths per 1,000 person-years. Adjusted median survival time was 262 percent greater in treated patients (survival time ratio 2.62, 95 percent confidence interval 2.27 to 3.02), and remained greater in every subgroup by surgery or chemotherapy. The authors concluded that most patients do not receive enzyme replacement and that the association suggests a lack of clinical awareness and a benefit from addressing malnutrition.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Pancreatology
- Year: 2019
- DOI: 10.1016/j.pan.2018.10.010
- Authors: Roberts KJ, Bannister CA, Schrem H.
- Findings: Enzyme replacement prescribed to 21.7 percent of 4,554 UK patients with pancreatic adenocarcinoma.; 807 propensity-matched pairs; mortality 748 versus 994 per 1,000 person-years.; Adjusted survival time ratio 2.62 (95 percent confidence interval 2.27 to 3.02), consistent across surgery and chemotherapy subgroups.
- What it means: Enzyme replacement is cheap, guideline-recommended (NICE NG85) and under-prescribed; the National Pancreatic Cancer Audit now reports the prescribing rate as a performance indicator, which the UK and NHS page tracks.
- Caveats: Observational; patients well enough to be prescribed and take enzymes may live longer for other reasons, and matching cannot remove all of that.; Primary care prescribing data may miss hospital-issued prescriptions.

## Sources

- Pancreatology 2019: https://doi.org/10.1016/j.pan.2018.10.010
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30385188/
- NICE NG85: pancreatic cancer in adults (2018), including enzyme replacement: https://www.nice.org.uk/guidance/ng85
- National Pancreatic Cancer Audit reports (NATCAN): https://www.natcan.org.uk/reports/?audit=pancreatic

## Connected records

- key papers: [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/), [Preservation of the pylorus in pancreaticoduodenectomy](https://onco.cc/key-papers/paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints](https://onco.cc/ideas/idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials/), [Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival](https://onco.cc/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/), [Raise the share of UK patients who receive any active treatment, and publish it by trust](https://onco.cc/ideas/idea-pdac-uk-active-treatment-rate-audit-and-target/)

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