Abstract
Pancreatic cancer is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries. More than 80% of patients suffer from significant weight loss at diagnosis and over time tend to develop severe cachexia. A major cause of weight loss is malnutrition. Patients may experience pancreatic exocrine insufficiency (PEI) before diagnosis, during nonsurgical treatment, and/or following surgery. PEI is difficult to diagnose because testing is cumbersome. Consequently, PEI is often detected clinically, especially in non-specialised centres, and treated empirically. In this position paper, we review the current literature on nutritional support and pancreatic enzyme replacement therapy (PERT) in patients with operable and non-operable pancreatic cancer. To increase awareness on the importance of PERT in pancreatic patients, we provide recommendations based on literature evidence, and when data were lacking, based on our own clinical experience.
Highlights
Pancreatic cancer (PC) is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries [1], the third most common cause of cancer death in the United States [2], and the fourth most common cancer death in Italy [3]
A similar number of patients suffer from significant weight loss at diagnosis, which can result in severe cachexia [6]
We aimed to increase the awareness on the importance of pancreatic exocrine insufficiency (PEI) and
Summary
Pancreatic cancer (PC) is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries [1], the third most common cause of cancer death in the United States [2], and the fourth most common cancer death in Italy [3]. One of the reasons for this might be that the nutritional support differs depending on production of tumour-specific factors such as islet amyloidcancer polypeptide (IAPP), the which the type of patient: Patients with unresectable pancreatic who undergo bestcontributes supportiveto cachexia and different the loss of appetite, and (iii) than the location the locally tumouradvanced/borderline itself, most often in the head of care may need nutritional support patientsofwith resectable the pancreas, resulting in the reduction of the secretion of pancreatic enzymes during meals [6]. One of the reasons for this might be that the nutritional support differs depending on the type of patient: Patients with unresectable pancreatic cancer who undergo the best supportive care may need different nutritional support than patients with locally advanced/borderline resectable (LA/BR) pancreatic cancer during neoadjuvant therapy, while resected patients may have their own specific needs [12] The goal of this position paper is two-fold: First, we aim to create and/or increase awareness on the importance of treating malnutrition and PEI in PC patients. We want to provide practical information on the different and appropriate PERT options for the different patient groups
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