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Enzyme replacement in advanced pancreatic cancer: patient perceptions
  1. Amanda Landers1,
  2. Clare McKenzie2,
  3. Suzanne G Pitama3 and
  4. Helen Brown2
  1. 1Department of Medicine, University of Otago, Christchurch, New Zealand
  2. 2Hospice and Palliative Care, Nurse Maude Association, Christchurch, New Zealand
  3. 3Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
  1. Correspondence to Dr Amanda Landers, Department of Medicine, University of Otago, Christchurch, New Zealand; Amanda.Landers{at}


Purpose Advanced pancreatic cancer has a universally poor survival rate. Patients frequently develop malabsorption that requires pancreatic enzyme replacement therapy (PERT). This study explores the experience of patient engagement with PERT and how the medication is taken and tolerated.

Methods Participants with advanced pancreatic cancer requiring PERT were interviewed after referral to a specialist palliative care team. An inductive analysis was used to code the data. Theoretical sufficiency was reached after 12 participants.

Results Four themes emerged from the interviews-patient context, health literacy, relationship to food and experience of taking the pancreatic enzymes. Respondents brought their own life experiences into the clinical encounter when told of the diagnosis. Patients had high levels of understanding and engagement with the diagnosis and treatment, understood the benefits of PERT in digestion and tolerated the medication well.

Conclusions Patients with metastatic pancreatic cancer understand the life-limiting nature of their illness. They want to participate in their healthcare decisions and are capable of complex medication titration when given good explanations and they experience benefits. PERT should be offered to these patients by a team of knowledgeable health professionals with good communication skills that can continue to support and review their needs.

  • Pancreatic
  • Education and training
  • Communication

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  • Contributors Initial research design and interview questionnaire were carried out by CM, AL, SGP and HB. CM was involved in data collection. CM, AL, SGP and HB were part of the data analysis and writing of the article. CM, AL, SGP and HB read and approved of the final draft. AL is responsible for overall content as guarantor.

  • Funding This study was funded by the Otago Medical School Trust Fund, University of Otago, Christchurch, New Zealand.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was obtained by the University of Otago Human Ethics Committee (Health H16/038).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are not in a repository state. The data are available from lead author on request but will be de-identified. The interview schedule would be available. Reuse in a publishable format is not permitted. Author can be contacted on