{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:28:39Z","timestamp":1786598919107,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post\u2010pancreatectomy exocrine insufficiency is common after resection for pancreatic cancer and requires pancreatic enzyme replacement therapy (PERT). We sought to determine the out\u2010of\u2010pocket cost of PERT and the association between PERT and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The SEER\u2010linked Medicare database was queried for patients with pancreatic cancer who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from 2010 to 2019. Cumulative out\u2010of\u2010pocket costs were calculated and stratified by procedure and radiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      11,854 Medicare beneficiaries with resected pancreatic cancer were identified, 4,653 (39%) required PERT and 7,201 (61%) did not. Median age was 73.0, 50.6% were female and 83.6% White. 25.9% underwent DP and 74.1% underwent PD; 7% received neoadjuvant radiation while 23.5% received adjuvant radiation. Logistic regression demonstrated that female sex (OR 1.25, 95% CI 1.16\u20101.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), neoadjuvant radiation (OR 1.93, 95% CI 1.67\u20102.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and PD (OR 2.45, 95% CI 2.23\u20102.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were risk factors for requiring PERT. Patients without subsidies who underwent DP paid a cumulative $4,736 out\u2010of\u2010pocket for PERT after 5 years, those who underwent PD paid $5,601 out\u2010of\u2010pocket.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly 40% of Medicare beneficiaries took PERT after resection for pancreatic cancer and paid thousands in out\u2010of\u2010pocket costs. While a conservative estimate, these findings highlight the importance of addressing this financial burden to patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70361","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:00:52Z","timestamp":1786597252000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Financial Burden of Pancreatic Enzyme Replacement Therapy for Patients With Resected Pancreatic Cancer"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0910-6701","authenticated-orcid":false,"given":"Patricia G.","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Surgery Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Hui H.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Services Mayo Clinic Arizona Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee\u2010Chee","family":"Stucky","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Potter","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George C.","family":"Linderman","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Fu Jeffrey","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Pannala","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Wasif","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi Ven","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"issue":"27","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"4298","DOI":"10.3748\/wjg.v27.i27.4298","article-title":"Pancreatic Cancer: A Review of Epidemiology, Trend, and Risk Factors","volume":"27","author":"Hu J. X.","year":"2021","journal-title":"World Journal of Gastroenterology"},{"issue":"20","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1001\/jama.2021.18859","article-title":"Incidence of Pancreatic Cancer by Age and Sex in the US, 2000\u20102018","volume":"326","author":"Gaddam S.","year":"2021","journal-title":"Journal of the American Medical Association (Chicago, IL)"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.21037\/jgo-24-213","article-title":"Pancreatic Cancer Mortality Trends in the United States: How Much Have We Moved the Needle?","volume":"15","author":"Tan J. Y.","year":"2024","journal-title":"Journal of Gastrointestinal Oncology"},{"issue":"11","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"2913","DOI":"10.1158\/0008-5472.CAN-14-0155","article-title":"Projecting Cancer Incidence and Deaths to 2030: The Unexpected Burden of Thyroid, Liver, and Pancreas Cancers in the United States","volume":"74","author":"Rahib L.","year":"2014","journal-title":"Cancer Research"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1200\/EDBK_175222","article-title":"Pancreatic Adenocarcinoma: Improving Prevention and Survivorship","volume":"37","author":"Sohal D. P. 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Y.","year":"2002","journal-title":"World Journal of Surgery"},{"issue":"2","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/bjs.9342","article-title":"Prospective Assessment of the Influence of Pancreatic Cancer Resection on Exocrine Pancreatic Function","volume":"101","author":"Sikkens E. C.","year":"2014","journal-title":"British Journal of Surgery"},{"issue":"6","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1159\/000333308","article-title":"Partial Pancreatic Resection for Pancreatic Malignancy Is Associated With Sustained Pancreatic Exocrine Failure and Reduced Quality of Life: A Prospective Study","volume":"11","author":"Halloran C. 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M.","year":"2020","journal-title":"HPB: The Official Journal of the International Hepato Pancreato Biliary Association"},{"issue":"2","key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.hpb.2019.07.008","article-title":"Completion of Adjuvant Therapy in Patients With Resected Pancreatic Cancer","volume":"22","author":"DePeralta D. K.","year":"2020","journal-title":"HPB: The Official Journal of the International Hepato Pancreato Biliary Association"},{"key":"e_1_2_9_31_1","doi-asserted-by":"crossref","first-page":"4108","DOI":"10.1245\/s10434-019-07602-6","article-title":"Completion of Adjuvant Chemotherapy After Upfront Surgical Resection for Pancreatic Cancer Is Uncommon Yet Associated With Improved Survival","volume":"26","author":"Altman A. M.","year":"2019","journal-title":"Annals of Surgical Oncology"},{"issue":"5","key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1038\/ajg.2013.430","article-title":"The FDA and Prescription Pancreatic Enzyme Product Cost","volume":"109","author":"Gardner T. B.","year":"2014","journal-title":"American Journal of Gastroenterology"},{"issue":"5","key":"e_1_2_9_33_1","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/j.hpb.2025.01.016","article-title":"Exocrine Pancreatic Insufficiency After Partial Pancreatectomy: Impact on Primary Healthcare Utilization and Expenditures","volume":"27","author":"Rahid Z.","year":"2025","journal-title":"HPB: The Official Journal of the International Hepato Pancreato Biliary Association"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70361","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70361","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70361","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:00:57Z","timestamp":1786597257000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":32,"alternative-id":["10.1002\/jso.70361"],"URL":"https:\/\/doi.org\/10.1002\/jso.70361","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"assertion":[{"value":"2026-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jso.70361"}}