{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:41:08Z","timestamp":1774590068485,"version":"3.50.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sanchez Ferguson Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exocrine pancreatic insufficiency (EPI), a common complication of pancreatic cancer (PC), reduces quality of life and may shorten survival. While pancreatic enzyme replacement therapy (PERT) improves symptoms and outcomes, real-world patterns of EPI workup and PERT use across PC subtypes remain poorly described in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 250 patients with resectable or metastatic PC from a single institution\u2019s prospectively maintained registry (2013\u20132018), collecting data on clinical characteristics, EPI symptoms, fecal elastase testing, and PERT prescriptions. In addition to the retrospective analysis, a quality improvement intervention for EPI management was implemented (1\/2021\u20131\/2023), and outcomes were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 250 patients, 97 underwent surgery for resectable disease and 153 received non-surgical management for metastatic PC. Exocrine pancreatic insufficiency symptoms occurred in 58% of metastatic and 68% of surgical patients. Fecal elastase testing was rarely performed (2% vs 9%, respectively). Pancreatic enzyme replacement therapy was prescribed to 46.5% of metastatic and 84% of surgical patients, but average doses were suboptimal (18\u2009500 vs 20\u2009000 USP units per meal; recommended: \u226540\u2009000). Among those on PERT, symptom resolution was reported in 33% of metastatic and 44% of surgical patients. Contrasting with results from the retrospective analysis, the quality improvement intervention led to 90% of 41 participants being prescribed PERT at an average dose of 44\u2009700 USP units per meal. Treated patients (74.1%) experienced complete resolution of EPI symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite prevalent EPI symptoms in PC patients, fecal elastase testing was infrequently utilized, and PERT was often underdosed. Educational initiatives are needed to improve guideline adherence and optimize outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag084","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T10:15:54Z","timestamp":1774088154000},"source":"Crossref","is-referenced-by-count":0,"title":["Disparities in the diagnosis and management of exocrine pancreatic insufficiency in resectable vs metastatic pancreatic cancer"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9261-0839","authenticated-orcid":false,"given":"Peiyun","family":"Ni","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Baglini","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Cancer Center , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Meurer","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Cancer Center , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorraine","family":"Drapek","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Cancer Center , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharvani","family":"Dhandibhotla","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yitong","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Science, Engineering and Technology, Brandeis University , Waltham, MA, 02453,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4599-2042","authenticated-orcid":false,"given":"Fateh","family":"Bazerbachi","sequence":"additional","affiliation":[{"name":"CentraCare, Interventional Endoscopy Program , St. Cloud Hospital, Saint Cloud, MN, 56303,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Weekes","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Cancer Center , Boston, MA, 02114,","place":["United States"]},{"name":"Department of Medical Oncology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David T","family":"Ting","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Cancer Center , Boston, MA, 02114,","place":["United States"]},{"name":"Department of Medical Oncology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinash","family":"Kambadakone","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Fernandez-del Castillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1266-3218","authenticated-orcid":false,"given":"Yasmin G","family":"Hernandez-Barco","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Massachusetts General Hospital , Boston, MA, 02114,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"2026032623544756100_oyag084-B1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/MOG.0000000000000459","article-title":"Diagnosis and treatment of pancreatic exocrine insufficiency","volume":"34","author":"Dominguez-Mu\u00f1oz","year":"2018","journal-title":"Curr Opin Gastroenterol"},{"key":"2026032623544756100_oyag084-B2","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3390\/nu9030183","article-title":"Pancreatic exocrine insufficiency in pancreatic cancer","volume":"9","author":"Vujasinovic","year":"2017","journal-title":"Nutrients"},{"key":"2026032623544756100_oyag084-B3","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.pan.2016.10.005","article-title":"Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic 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