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

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 euroendocrine 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%; pvalue 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, articularly due to its potential impact on ability to deliver chemotherapy and its effect on survival.