Quality statement 4: Pancreatic enzyme replacement therapy

Quality statement

Adults with unresectable pancreatic cancer are prescribed enteric-coated pancreatin.

Rationale

Pancreatic cancer inhibits the ability of the pancreas to deliver pancreatic enzymes, which assist digestion and absorption of fat, carbohydrates and proteins. Enteric-coated pancreatin can improve the nutritional status and wellbeing of people with pancreatic cancer and, as a result, their ability to tolerate treatment.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults with unresectable pancreatic cancer are prescribed enteric-coated pancreatin.

Data source: Local data collection, for example service specification or local protocols.

b) Evidence of local arrangements to ensure that adults with unresectable pancreatic cancer prescribed enteric-coated pancreatin receive advice on how to take it.

Data source: Local data collection, for example service specification or local protocols.

Process

Proportion of adults with unresectable pancreatic cancer prescribed enteric-coated pancreatin.

Numerator – the number in the denominator prescribed enteric-coated pancreatin.

Denominator – the number of adults with unresectable pancreatic cancer.

Data source: Local data collection, for example patient records.

Outcome

a) Malnutrition Universal Screening Tool (MUST) score in adults with unresectable pancreatic cancer.

Data source: Local data collection, for example patient records.

b) Health-related quality of life in people with pancreatic cancer.

Data source:  National cancer patient experience survey.

What the quality statement means for different audiences

Service providers (secondary and tertiary services, dietetics services and specialist regional centres) ensure that adults with unresectable pancreatic cancer are prescribed enteric-coated pancreatin and given advice on how to use it effectively.

Healthcare professionals (such as GPs, dieticians, pancreatic cancer nurse specialists and members of the local cancer network) prescribe enteric-coated pancreatin to adults with unresectable pancreatic cancer and explain how to use it effectively.

Commissioners (clinical commissioning groups) ensure that they commission services in which adults with unresectable pancreatic cancer are prescribed enteric-coated pancreatin and given advice on how to use it effectively.

Adults with pancreatic cancer that cannot be treated with surgery are given a medicine called pancreatin, which makes it easier to digest food and absorb nutrients. They are given information about how to take the pancreatin tablets to make sure they work as well as possible. Pancreatin can help them to keep their weight stable, feel better, have more energy for normal daily activities and cope with their cancer treatment.

Source guidance

Pancreatic cancer in adults: diagnosis and management (2018) NICE guideline NG85, recommendation 1.6.1

Equality and diversity considerations.

Currently, pancreatic enzyme supplements are made from pork products that may be unacceptable for some people because of their religion or beliefs. People with pancreatic cancer need to be made aware of the ingredients to make an informed decision.