{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T10:38:52Z","timestamp":1792492732315,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Exocrine pancreatic insufficiency (EPI) is a highly prevalent, yet modifiable determinant of treatment tolerance in pancreatic cancer (PC). Despite its clinical significance, management remains inconsistent due to a lack of oncology-specific guidelines. This project aimed to establish the first U.S. multidisciplinary consensus to standardize pancreatic enzyme replacement therapy (PERT) dosing, education, and longitudinal management in pancreatic oncology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A mixed-methods design was employed, integrating a parallel literature review, six virtual focus groups with patients and clinicians (n\u2009=\u200928), and a formal modified Delphi process. A multidisciplinary panel of 17 experts, including medical, surgical, and radiation oncologists, advanced practice providers, and oncology dietitians, independently rated and refined draft statements over two iterative rounds. Consensus was defined a priori as\u2009\u2265\u200970% agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The process yielded 15 final Consensus Statements, all achieving \u2265 81% agreement. This manuscript highlights a critical subset of six statements focusing on clinical application (CS 10\u201315), which achieved 94%\u2013100% consensus. Recommendations define standardized starting doses (48,000\u201372,000 lipase units per meal), evidence-based titration protocols, multi-level patient education requirements, and strategies to mitigate financial toxicity and pill burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>These consensus statements provide a practical, evidence-based framework to reduce provider inertia and practice variability. Broad implementation of these standards offers a vital opportunity to stabilize nutritional status, improve quality of life, and optimize treatment continuity for patients with PC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag389","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:44:00Z","timestamp":1792489440000},"source":"Crossref","is-referenced-by-count":0,"title":["Pancreatic Enzyme Replacement Therapy (PERT) in Pancreatic Cancer: First U.S. Consensus Highlights on Dosing, Management, and Provider Inertia"],"prefix":"10.1093","author":[{"given":"Dallas","family":"Gallagher","sequence":"first","affiliation":[{"name":"UC San Diego Departments of Medicine and Surgery, Divisions of Hematology-Oncology and Surgical Oncology, Moores Cancer Center, , La Jolla, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Yaceczko","sequence":"additional","affiliation":[{"name":"University of California Los Angeles (UCLA) Division of Digestive Diseases, , Los Angeles, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Stanford Health Care Department of Clinical Nutrition, , Stanford, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Cox","sequence":"additional","affiliation":[{"name":"Tisch Cancer Institute, The Mount Sinai Hospital , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelli","family":"Hardy","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center Department of Clinical Nutrition, , Dallas, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailey","family":"Irvin","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center Department of Clinical Nutrition, , Dallas, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitland","family":"Lauterbach","sequence":"additional","affiliation":[{"name":"Lynn Cancer Institute, Baptist Health South Florida , Boca Raton, FL,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Hacker-Prietz","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Department of Oncology, , Baltimore, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary-Eve","family":"Brown","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Department of Oncology, , Baltimore, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Q B","family":"Petzel","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center Department of Clinical Nutrition and Department of Surgical Oncology, , Houston, TX,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine B","family":"Mills","sequence":"additional","affiliation":[{"name":"Dartmouth Cancer Center Department of Clinical Nutrition, , Lebanon, NH,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassadie","family":"Moravek","sequence":"additional","affiliation":[{"name":"Pancreatic Cancer Action Network (PanCAN) , El Segundo, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Rosenzweig","sequence":"additional","affiliation":[{"name":"Pancreatic Cancer Action Network (PanCAN) , El Segundo, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Polaris Global Health Solutions , Austin, TX, USA (Organization where the work was conducted)"},{"name":"Independent Consultant , Austin, TX, USA (Current correspondence\/contact)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,20]]},"container-title":["The Oncologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/oncolo\/advance-article-pdf\/doi\/10.1093\/oncolo\/oyag389\/72128451\/oyag389.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/advance-article-pdf\/doi\/10.1093\/oncolo\/oyag389\/72128451\/oyag389.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:44:00Z","timestamp":1792489440000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oncolo\/advance-article\/doi\/10.1093\/oncolo\/oyag389\/8943987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/oncolo\/oyag389","relation":{},"ISSN":["1083-7159","1549-490X"],"issn-type":[{"value":"1083-7159","type":"print"},{"value":"1549-490X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"article-number":"oyag389"}}