OpenSAFELY
Reports

This is a report produced using the OpenSAFELY Platform by: University of Surrey

The impact of COVID-19 on prescribing of pancreatic enzyme replacement therapy for people with unresectable pancreatic cancer in England. A cohort study using OpenSafely-TPP

Description
This dashboard shows prescribing of pancreatic enzyme replacement therapy (PERT) for people with unresectable pancreatic cancer in England
Authors
Agnieszka Lemanska, Colm Andrews, Louis Fisher, Benjamin Butler-Cole, Amir Mehrkar, Keith J Roberts, Ben Goldacre, Alex J Walker, Brian MacKenna
Contact
Get in touch and tell us how you use this report or new features you'd like to see: team@opensafely.org
First published
15 Jan 2023
Last released
11 Jan 2023
DOI
http://doi.org/10.53764/rpt.a0b1b51c7a
Links
University of Surrey logo

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

This dashboard shows prescribing of pancreatic enzyme replacement therapy (PERT) for people with unresectable pancreatic cancer in England.

Produced using OpenSAFELY-TPP

Updatd 2-monthly, next update due March 2023

The full text of this study has been published here



Abstract

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 30th November 2022 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 2022. There was substantial regional variation. The highest rates of 50% to 60% were in the West Midlands and lowest (20% to 30%) in London.

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 2022, 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 1. Study flowchart explaining inclusion and exclusion criteria. Each month the rate was calculated of people receiving pancreatic enzyme replacement therapy (numerator) among people with unresectable pancreatic cancer (denominator).

Figure 1. Study flowchart explaining inclusion and exclusion criteria. Each month the rate was calculated of people receiving pancreatic enzyme replacement therapy (numerator) among people with unresectable pancreatic cancer (denominator).



Results

National rates and the effect of the COVID-19 pandemic

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 48% in 2022 (Figure 2).



Figure 2. Prescribing rates in England

Figure 2. Prescribing rates in England



Regional rates

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. Throughout the study period, the lowest rates of between 20% to 30% were in the London region. The effect of COVID-19 was the most pronounced in the West Midlands area with a dip in rates by nearly 10% (from 50% to 40%) in July 2020. This recovered by September 2020 to higher than the pre-pandemic levels.