Vibhu Chittajallu, MD1, Ian N. Monk, MD1, Mohannad Abou Saleh, MD1, Adrian Lindsey, MD2, Jamie S. Barkin, MD, MACG3, Jodie A. Barkin, MD3, Carlos Roberto Simons-Linares, MD, MSc1; 1Cleveland Clinic Foundation, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 3University of Miami Miller School of Medicine, Miami, FL
Introduction: Exocrine pancreatic insufficiency (EPI) is a known complication of pancreatic cancer (PC), occurring in 25-75% of patients based on stage. Pancreatic enzyme replacement therapy (PERT) is the mainstay of EPI therapy to prevent malnutrition, morbidity and mortality. We aim to investigate the prevalence of and factors influencing EPI treatment with PERT in PC. Methods: We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems to identify a cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) diagnosis of PC. We identified patients who were prescribed PERT after PC diagnosis. We performed a case control study comparing patients with PC with and without PERT. Logistic regression models were constructed. Results: Of the 64,213,430 individuals in the database, we identified 58,530 (0.09%) with PC. Of those, 5540 (9.47%) were prescribed PERT. Patients prescribed PERT were more likely to be younger (< 65 years old) [OR 1.204; 95%CI 1.1694-1.3151; p< 0.0001] and Caucasian [OR 1.693; 95%CI 1.5726-1.8226; p< 0.0001], while African American patients were less likely to receive PERT [OR 0.7281; 95%CI 0.6628-0.7998; p< 0.0001]. Patients who were non-smokers [OR 2.6894; 95%CI 2.5277-2.8615; p< 0.0001] and marijuana users [OR 2.067; 95%CI 1.6433-2.5998; p< 0.0001] were more likely to be prescribed PERT. PERT was more likely to be prescribed if history of chronic pancreatitis [OR 2.9572; 95%CI 2.7253-3.2089; p< 0.0001], malnutrition [OR 2.4592; 95%CI 2.2888-2.6423; p< 0.0001], bariatric surgery [OR 2.1705; 95%CI 1.7617-2.6741; p< 0.0001], and Vitamin D deficiency [OR 2.057; 95%CI 1.9192-2.2047; p< 0.0001] (table 1). Discussion: In this large database study, EPI in PC remains undertreated with only 9.47% of patients being prescribed PERT. Lack of PERT prescription disproportionately affects older and African American patients. Patients with comorbid conditions known to be associated with EPI (ie. chronic pancreatitis, malnutrition, bariatric surgery, Vitamin D deficiency) were more likely to be prescribed PERT. Strategies aimed at improving gaps in treatment of EPI in PC and addressing healthcare disparities are needed to reduce associated morbidity and mortality.
Table 1: PERT prescriptions based on patient demographics
Disclosures: Vibhu Chittajallu indicated no relevant financial relationships. Ian Monk indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Adrian Lindsey indicated no relevant financial relationships. Jamie Barkin: AbbVie – Consultant. Jodie Barkin: AbbVie – Advisory Committee/Board Member. Carlos Roberto Simons-Linares indicated no relevant financial relationships.