Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA)

Lindsay E Carnie; Dinakshi Shah; Kate Vaughan; Zainul Abedin Kapacee; Lynne McCallum; Marc Abraham; Alison Backen; Mairéad G McNamara; Richard A Hubner; Jorge Barriuso; Loraine Gillespie; Angela Lamarca; Juan W Valle

doi:10.3390/cancers15082277

Prospective Observational Study of Prevalence, Assessment and Treatment of Pancreatic Exocrine Insufficiency in Patients with Inoperable Pancreatic Malignancy (PANcreatic Cancer Dietary Assessment-PanDA)

Cancers (Basel). 2023 Apr 13;15(8):2277. doi: 10.3390/cancers15082277.

Authors

Lindsay E Carnie¹, Dinakshi Shah², Kate Vaughan^{2

3}, Zainul Abedin Kapacee², Lynne McCallum⁴, Marc Abraham¹, Alison Backen^{2

3}, Mairéad G McNamara^{2

3}, Richard A Hubner^{2

3}, Jorge Barriuso^{2

3}, Loraine Gillespie¹, Angela Lamarca^{2

3}, Juan W Valle^{2

3}

Affiliations

¹ Nutrition & Dietetics, The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
² Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
³ Division of Cancer Sciences, University of Manchester, Manchester M20 4BX, UK.
⁴ Pancreatic Cancer UK, London SE1 7SP, UK.

Abstract

Introduction: Pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC) is well documented, but there is no consensus regarding optimal screening.

Methods and analysis: Patients diagnosed with aPC referred for palliative therapy were prospectively recruited. A full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair-climb test), nutritional blood panel, faecal elastase (FE-1) and ¹³C-mixed triglyceride breath tests were performed.

Primary objective: prevalence of dietitian-assessed PEI (demographic cohort (De-ch)); design (diagnostic cohort (Di-ch)) and validation (follow-up cohort (Fol-ch)) of a PEI screening tool. Logistic and Cox regressions were used for statistical analysis.

Results: Between 1 July 2018 and 30 October 2020, 112 patients were recruited (50 (De-ch), 25 (Di-ch) and 37 (Fol-ch)). Prevalence of PEI (De-ch) was 64.0% (flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)). The derived PEI screening panel (Di-ch) included FE-1 (normal/missing (0 points); low (1 point)) and MUAC (normal/missing (>percentile 25) (0 points); low (2 points)) and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from the De-ch and Di-ch were analysed together, those classified by the screening panel as "high-risk" had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040). The screening panel was tested in the Fol-ch; 78.4% patients classified as "high-risk", of whom 89.6% had dietitian-confirmed PEI. The panel was feasible for use in clinical practice (64.8% patients completed all assessments), with high acceptability (87.5% would repeat it). Most patients (91.3%) recommended dietetic input for all patients with aPC.

Conclusions: PEI is present in most patients with aPC; early dietetic input provides a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel may help to prioritise those at higher risk of PEI, requiring urgent dietitian input. Its prognostic role needs further validation.

Keywords: exocrine insufficiency; gastrointestinal tumours; nutrition support; pancreatic disease.

Abstract

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