Pancreatic cancer continues to have one of the most dismal prognoses of all malignancies, despite advances in the treatment and survival of many other cancers. Standard therapeutic approaches include surgery (when feasible), chemotherapy, and radiation. A frequently overlooked, yet critical, aspect of pancreatic cancer care is the high prevalence of pancreatic exocrine insufficiency (PEI). PEI results in malabsorption, which contributes to a range of debilitating digestive symptoms and progressive weight loss—factors that significantly diminish quality of life. The cornerstone of PEI management is pancreatic enzyme replacement therapy (PERT), which requires careful initiation, titration, and ongoing monitoring by experienced clinicians. PERT is safe, improves nutritional status and quality of life, and likely contributes to improved survival in people with pancreatic cancer.
Our research has highlighted the significant burden of digestive symptoms in this population, and how these symptoms markedly improve with optimal PERT use. Despite this, we identified a large proportion of patients in both Australia and Aotearoa New Zealand who are not receiving PERT. Access disparities were most pronounced among regional healthcare providers, with urban and rural areas performing better in comparison. Even when PERT was prescribed, dosing and administration instructions were often inadequate. Clinicians frequently failed to use existing patient-centered resources and evidence-based guidelines. Our qualitative findings underscored that patients tolerated PERT well, and when provided with clear information, were capable of managing complex titration independently. Many reported that PERT transformed their relationship with food, reduced anxiety around eating, and improved their ability to participate in social activities.
Our research also revealed a lack of clinician confidence in diagnosing and managing PEI. Notable differences emerged between Australia and Aotearoa New Zealand in the approach to diagnosis and subsequent treatment planning.
This presentation will explore these research findings, highlighting key barriers and enablers to PERT access and implementation. We will conclude with practical recommendations to improve the uptake and optimisation of PERT in pancreatic cancer care. Finally, we will outline our upcoming research initiatives, including a bedside diagnostic study for PEI and a randomised controlled trial focused on implementation strategies to ensure equitable access to PERT across healthcare settings.