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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.
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.
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.
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