None listed
Conditions
Brief summary
Introduction: Advanced pancreatic cancer has a poor prognosis and is associated with a constellation of symptoms leading to poor quality of life. Malabsorption (MA) due to pancreatic exocrine dysfunction is common and can cause bloating/fullness, flatulence, weight loss and steatorrhoea, and may develop without obvious clinical signs. Pancreatic enzyme replacement therapy, which can alleviate MA, is underutilised in advanced pancreatic cancer (APC). A recent study found 80% of advanced pancreatic cancer patients were not prescribed PERT, in spite of exhibiting symptoms consistent with MA. Objectives: To determine the efficacy of PERT in improving MA symptoms, and consequent impact on global and pancreas-specific quality of life (QOL) in APC patients. Method: Consecutive patients with advanced pancreatic cancer referred to Nurse Maude Hospice Palliative Care Service not previously prescribed PERT were enrolled on this study. PERT (CREON 25,000) was initiated following dietary and symptom assessment by a specialist dietitian. QOL was assessed using the EORTC-QLQ C30 v3 and PAN26 questionnaires at baseline and at 1 and 3 weeks of PERT
Interventions
1. This is an observational trial of best practice. This is not an interventional trial. Malabsorption symptoms - each patient will be assessed by the dietician, or clinical nurse specialist or palliative physician for malabsorption and offered treatment with enzyme replacement therapy (PERT). If the patient consents to taking PERT, symptoms will be recorded at the initial assessment and at 7 and 21 days after taking PERT or until the following endpoints - the patient is unable to swallow tabl
1. This is an observational trial of best practice. This is not an interventional trial. Malabsorption symptoms - each patient will be assessed by the dietician, or clinical nurse specialist or palliative physician for malabsorption and offered treatment with enzyme replacement therapy (PERT). If the patient consents to taking PERT, symptoms will be recorded at the initial assessment and at 7 and 21 days after taking PERT or until the following endpoints - the patient is unable to swallow tablets, is discharged from the service or dies. Any side effects of PERT (e.g. constipation) will be also noted. 2. Nutritional assessment - the dietician will perform a nutritional assessment and recommend dietary changes based on the patient’s identified needs. If the patient agrees to commence PERT, the dietician will provide an education pamphlet on the action of PERT for the patient and carer. The dietician will also liaise with the Hospice Medical Specialist regarding appropriate dosages of PERT to be prescribed according to the patient’s meal requirements. The effectiveness of PERT on malabsorption symptoms will be reviewed weekly and dosages increased through GP liaison. 3. This study will also measure quality of life in this patient group using the EORTC QLQ C30 and PAN26 instruments. The PAN26 instrument has been tested internationally and comprises 26 questions assessing pain, dietary changes, jaundice, altered bowel habit, emotional problems related to pancreatic cancer, and other symptoms (cachexia, indigestion, flatulence, dry mouth, taste changes). Measurement of quality of life will be recorded at the initial visit and then at 7 and 21 days after taking PERT or until the following endpoints - the patient is unable to swallow tablets, is discharged from the service or dies.
Sponsors
Nurse Maude Association
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients with advanced pancreatic cancer referred to Nurse Maude's Palliative Care (NMPC) service will be eligible for the study until 50 patients in total have been recruited. The intervention will be given to patients who have had pancreatic surgery and those who have not, as exocrine pancreatic insufficiency (EPI) can be caused by tumour-related pancreatic duct obstruction (Fieker et al, 2009).
Exclusion criteria
Those patients who have cognitive impairment or are unable to complete the quality of life questionnaire for any reason, including language difficulties, will be excluded.. Patients who have been prescribed PERT already.
Outcome results
None listed