Almost 10 years ago a dietitian and two palliative care physicians attended a journal club about nutrition and cancer.
Talking afterwards, we realised patients with pancreatic cancer being referred to our local community palliative care service did not appear to be taking enzyme replacement treatment (PERT) despite the medication being well-tolerated and funded.
PERT helps prevent malabsorption of food through enzyme replacement, as well as improving digestive symptoms. A local audit revealed only 21 per cent were on PERT despite over 70 per cent having the symptoms of malabsorption. With few resources and little research infrastructure for palliative medicine we teamed up with a local oncologist to conduct a non-randomised pre- and post-PERT study focusing on quality of life. We found significant improvements in pancreatic pain and other symptoms. Our next research project was qualitative, exploring the experience of taking PERT by asking those with pancreatic cancer. The themes from that study revealed high health literacy about their illness, an improved relationship with food and good tolerability of the medication.
In 2019, the Canterbury research team reached out to Auckland colleagues interested in this area and the network began to grow. The Palliative Care Clinical Studies Collaborative based at the University of Technology Sydney endorsed the research team work and we now have a formal partnership with this federally-funded entity. ASPERT was born and the research alliance now has 18 members spanning both Australia and New Zealand, with representation from allied health, consumers, surgery, oncology, palliative care and academics.
We have developed a programme of work which will take us through to 2023/24 focused on finding knowledge gaps regarding PERT. A systematic literature review of the impact of PERT on those with pancreatic cancer reported few research articles in this area. We have developed a population survey for Australia and New Zealand which will ask people with this malignancy their experience of PERT including education, prescribing, compliance and access. Next year, we will be asking Australasian clinicians their understanding of PERT, how and why they use it in clinical practice. The overall mission is to improve the access of people with pancreatic cancer to high-quality nutritional advice, PERT and ultimately, an improved quality of life.
New Zealand Research team
- Dr Amanda Landers – Palliative Care Physician, University of Otago, Department of Medicine, ASPERT lead investigator
- Helen Brown – Dietitian, Nurse Maude Association
- Clare McKenzie – Clinical Nurse Specialist, Nurse Maude Association
- Dr Matthew Strother – Medical Oncologist, University of Otago, Department of Medicine
- Prof John Windsor – Surgeon, ADHB, Department of Surgery
- Kylie Russell – Dietitian, ADHB
- Charlotte Cahill – Research Assistant, University of Otago