This is a report produced using the OpenSAFELY Platform by: University of Surrey
This dashboard is hosted on the OpenSAFELY Reports website on behalf of the University of Surrey
PERT prescribing in pancreatic cancer
First created January 2023
Produced using OpenSAFELY-TPP
Last updated October 2023
Updated 3-monthly, next update due: January 2024
The full text of this study has been published here
Background: Cancer treatments were variably disrupted during the COVID-19 pandemic. Despite UK national guidelines recommending pancreatic enzyme replacement therapy to all people with unresectable pancreatic cancer, observational studies demonstrate under-prescribing
Aim: To investigate the impact of the COVID-19 pandemic on the prescribing of pancreatic enzyme replacement to people with unresectable pancreatic cancer.
Methods: With the approval of NHS England, we conducted a cohort study using 24 million health records through the OpenSAFELY-TPP research platform. We modelled prescribing rates from 1st January 2015 to 31st October 2023 and investigated the effect of COVID-19 with multivariable linear regression.
Results We found no reduction in pancreatic enzyme replacement therapy during the COVID-19 pandemic. Overall, since 2015, the rates of prescribing increased steadily over time by 1% every year. The national rates ranged from 41% in 2015 to 50% in 2023. There was substantial regional variation. The highest rates of 50% to 60% were in the West Midlands.
Conclusions: The COVID-19 pandemic did not affect PERT prescribing in unresectable pancreatic cancer. Although overall rates increased over time, substantial under-prescribing persists. At just under 50% in 2023, the rates were still below the recommended 100% standard. Despite the national guidelines, under-prescribing of PERT continued and has improved only marginally since their publication. This could be an important missed opportunity to reduce morbidity for patients with pancreatic cancer. The research into barriers to prescribing of PERT and geographic variation is urgently needed to improve quality of care.
Figure 2 shows the rates in prescribing over time in England. Overall, the COVID-19 pandemic did not affect PERT prescribing to people with unresectable pancreatic cancer. A small decrease in rates, by about 3% (from 46% to 43%), was observed at the beginning of the pandemic from March to July 2020. This dip in rates could potentially be associated with the effect of the COVID-19 healthcare crisis. However, the rates of prescribing recovered by September 2020 to rates that would be expected if the pandemic had not occurred.
In view of the national target rate of 100%, the national trend increased gradually over time on average by 1% every year, ranging from 41% in 2015 to 50% in 2023 (Figure 2).
Figure 3 shows the rates in prescribing by regions in England. The highest rates, achieving values between 50% and 60% from 2018 onwards were in the West Midlands region. Please note, data for London is limited in this dataset and therefore the representativeness of figures for London is limited and difficult to assess. The effect of COVID-19 was the most pronounced in the North East area with a dip in rates by nearly 10% (from 40% to 30%). This recovered by the end of 2022 to higher than the pre-pandemic levels.