Project 458181

Inoperable pancreatic cancer (IPC) is a terminal diagnosis with distressing symptoms including diarrhea, bloating and weight loss. Pancreatic tumors block the path of digestive enzymes, causing poor digestion and nutrient malabsorption. The resulting symptoms make eating difficult, hastening malnutrition. The hallmark of malnutrition is muscle wasting, which can reduce function, independence and survival. Oral pancreatic enzyme capsules are used to improve digestion in other pancreatic diseases, but their value for patients with IPC is unclear. The aim of this research is to determine whether oral enzymes can prevent muscle wasting and reduce digestive symptoms for people with IPC during chemotherapy. Two simultaneous studies are being conducted to address these questions. To determine whether enzymes preserve muscle, we will evaluate data from over 400 people diagnosed with IPC in Alberta from 2013-2019. Those diagnosed in 2018 and 2019 received enzymes as part of their usual care, while those diagnosed prior did not. All patients were similarly treated with chemotherapy. Using computed tomography (CT) scans taken during usual care to identify muscle loss, we will compare the risk of muscle wasting between the two groups. To understand how enzymes influence symptoms, newly diagnosed patients with IPC will be invited to complete a questionnaire about their digestive symptoms before starting enzymes and after 4, 12 and 24 weeks. We will look for changes in symptom scores to determine whether enzyme use improves symptoms at each time point. We will also explore the effects of enzyme dose, chemotherapy type and disease progression. The outcomes of this research will provide vital evidence to help clinicians and patients decide collaboratively whether to use enzymes during chemotherapy for IPC. Publishing these results and sharing at conferences will contribute to guideline development for enzyme use so that all Canadians receive consistent care for IPC.