Nutritional therapy when it is needed Enzyme replacement therapy can make a big difference to cancer patients, as Mary-Claire Mason reports occurs when the organ’s ability to secrete enzymes needed to digest food is compromised. The main nutritional therapy for such patients is pancreatic enzyme replacement therapy (PERT), which is usually given in capsule form and taken with food, with doses taken throughout the meal or snack. Ms McCallum decided to investigate how many patients received nutritional therapy and if it affected outcomes. With the support of two other clinicians, she carried out a retrospective study in 2013 of 183 patients at the Christie who had had some form of
pancreatic malignancy. The study found that only 43% of patients had been given nutritional intervention, mainly PERT. Those who received an intervention survived longer than those who did not (10.2 months compared to 6.9 months), although Ms McCallum cautions that more research is needed into survival time. She is confident, however, that treating malnourished patients as early as possible is important, as they do not recover quickly from surgery and may be too weak for chemotherapy.
Fear of eating
She says: ‘Quality of life can be significantly affected. Malnourished patients can experience a loss of energy, abdominal discomfort and pain, and food smells may make them nauseous. Patients become frightened of eating as they feel so unwell afterwards.’ In most patients PERT was initiated because of a particular symptom, steatorrhoea – pale, foul-smelling stools
SUMMARY
SPL
Clinical nurse specialist Lynne McCallum has worked for the past three years at the Christie Hospital in Manchester, where she specialises in pancreatic malignancies. About a year into the job, she started to notice that ‘the biggest issue patients were struggling with was nutrition and weight loss’. Ms McCallum says 80-90% of patients with pancreatic cancer will have some degree of pancreatic enzyme insufficiency (PEI), a condition that
which are difficult to flush due to their excess fat content. The study highlighted other symptoms of malnourishment, such as weight loss, abdominal discomfort and diarrhoea, which could help identify PEI and lead to nutritional therapy at a much earlier stage. Ms McCallum’s work has won her an innovation award from the charity Pancreatic Cancer UK and helped change practice at the Christie. Patients with weight loss and/or other symptoms linked to malnourishment are now started on PERT, while those with no symptoms are screened for PEI, using a faecal elastase test. Ms McCallum’s current research aim is to look at all screening methods and assess whether some patients with certain types of pancreatic malignancies should automatically be given PERT. Prognosis for patients with pancreatic cancer is poor, with only about 3% surviving five years or more. ‘It is vital to know your patient’s nutritional status and whether they have some degree of pancreatic enzyme insufficiency,’ she says. Ms McCallum emphasises that PERT is for life and should be regarded as a nutritional supplement rather than a medicine. ‘It is taken as a capsule with the dose tailored to each patient. Patients need to be taught how to take it as it can make a big difference to their health and wellbeing’ NS For information go to www.pancreaticcancer.org.uk/ health-professionals [email protected]
Most patients with pancreatic cancer are deficient in the enzymes they need to digest food, leaving them at risk of becoming malnourished. Research by Lynne McCallum has highlighted the importance of early pancreatic enzyme replacement therapy. Author Mary-Claire Mason is a freelance journalist
april No 29 other :: vol uses 29 no 35 :: permission. 2015 21 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. without Copyright © 2015 RCNi Ltd. All rights reserved.
pancreatic malignancy. The study found that only 43% of patients had been given nutritional intervention, mainly PERT. Those who received an intervention survived longer than those who did not (10.2 months compared to 6.9 months), although Ms McCallum cautions that more research is needed into survival time. She is confident, however, that treating malnourished patients as early as possible is important, as they do not recover quickly from surgery and may be too weak for chemotherapy.
Fear of eating
She says: ‘Quality of life can be significantly affected. Malnourished patients can experience a loss of energy, abdominal discomfort and pain, and food smells may make them nauseous. Patients become frightened of eating as they feel so unwell afterwards.’ In most patients PERT was initiated because of a particular symptom, steatorrhoea – pale, foul-smelling stools
SUMMARY
SPL
Clinical nurse specialist Lynne McCallum has worked for the past three years at the Christie Hospital in Manchester, where she specialises in pancreatic malignancies. About a year into the job, she started to notice that ‘the biggest issue patients were struggling with was nutrition and weight loss’. Ms McCallum says 80-90% of patients with pancreatic cancer will have some degree of pancreatic enzyme insufficiency (PEI), a condition that
which are difficult to flush due to their excess fat content. The study highlighted other symptoms of malnourishment, such as weight loss, abdominal discomfort and diarrhoea, which could help identify PEI and lead to nutritional therapy at a much earlier stage. Ms McCallum’s work has won her an innovation award from the charity Pancreatic Cancer UK and helped change practice at the Christie. Patients with weight loss and/or other symptoms linked to malnourishment are now started on PERT, while those with no symptoms are screened for PEI, using a faecal elastase test. Ms McCallum’s current research aim is to look at all screening methods and assess whether some patients with certain types of pancreatic malignancies should automatically be given PERT. Prognosis for patients with pancreatic cancer is poor, with only about 3% surviving five years or more. ‘It is vital to know your patient’s nutritional status and whether they have some degree of pancreatic enzyme insufficiency,’ she says. Ms McCallum emphasises that PERT is for life and should be regarded as a nutritional supplement rather than a medicine. ‘It is taken as a capsule with the dose tailored to each patient. Patients need to be taught how to take it as it can make a big difference to their health and wellbeing’ NS For information go to www.pancreaticcancer.org.uk/ health-professionals [email protected]
Most patients with pancreatic cancer are deficient in the enzymes they need to digest food, leaving them at risk of becoming malnourished. Research by Lynne McCallum has highlighted the importance of early pancreatic enzyme replacement therapy. Author Mary-Claire Mason is a freelance journalist
april No 29 other :: vol uses 29 no 35 :: permission. 2015 21 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. without Copyright © 2015 RCNi Ltd. All rights reserved.
