Editor’s note: In recognition of National Nutrition Month, we’re featuring a special series for our Friday Fix called, “Ask a Dietitian.” The series focuses on the most common nutrition-related questions that dietitians get from their pancreatic cancer patients, plus answers and additional resources. Today’s topic: pancreatic enzymes. Check back next Friday to see other commonly asked questions and answers.
Enzymes are proteins secreted by the pancreas to break down the food we eat. Often, pancreatic tumors prevent this process, causing enzyme insufficiency. Treatments for pancreatic cancer can also be a cause.
Malabsorption of (inability to absorb) nutrients due to enzyme insufficiency can lead to much discomfort and weight loss – symptoms that can dramatically affect patients’ quality of life and their ability to tolerate treatment. But taking prescription pancreatic enzymes, also known as pancreatic exocrine replacement therapy (PERT), functions to replenish enzymes and alleviate related symptoms.
According to the Pancreatic Cancer Action Network’s (PanCAN) PanCAN Patient Services findings based on patient feedback, many are not told about their potential need for pancreatic enzymes and how critical they are for the breakdown and absorption of nutrients.
When they are aware, they often have questions.
Mills is clinical oncology dietitian for the Norris Cotton Cancer Center and a member of PanCAN’s Scientific and Medical Advisory Board (SMAB).
Petzel is senior clinical dietitian for the Pancreas Surgery Program at MD Anderson Cancer Center and an emeritus member of PanCAN’s SMAB.
Question: What foods do I take enzymes with?
Answer: For best results, take enzymes with every meal or snack that contains fat, especially meat, dairy, bread, desserts and nutrition supplement drinks.
Take your first capsule with the first bite of food or drink. If taking multiple capsules, spread additional capsules throughout the rest of the meal.
Enzymes generally do not work well if forgotten and only taken at the end of the meal. Start with the smallest dose necessary and adjust according to the severity of the pancreatic insufficiency symptoms.
Question: How long will I need to stay on pancreatic enzymes?
Answer: Some patients need enzymes before having any treatment. Others develop the need for enzymes the longer they live with pancreatic cancer (but do not have surgery). These patients usually need to be on enzymes for the rest of their lives.
For those patients who started on enzymes after surgery, some may need them for a few months or years after surgery and others will need to take supplemental enzymes for life.
Patients who needed enzymes before surgery, and those who have radiation therapy along with the Whipple procedure, are much more likely to have long-term malabsorption and need to stay on enzymes long-term.
Question: What if I can’t afford to pay for enzymes?
Answer: Pancreatic enzymes can be key to a pancreatic cancer patient’s wellbeing and quality of life, but correct enzyme use is critical for them to be effective. We often hear from patients and their families that paying for enzymes can be a challenge.
Insurance coverage, including Medicare, may vary for pancreatic enzymes.
There are five FDA-approved pancreatic enzyme products, and insurance companies often have one brand for which there is a lower copay amount.
Even those patients with insurance may find themselves in the “donut hole,” or coverage gap, resulting in a large copay that can last for several months.
Question: What resources are available for patients to help reduce cost?
Answer: For those struggling with the cost of enzymes, there are resources to help. PanCAN suggests:
- Check your insurance’s prescription formulary to find out if one brand is preferred over another, which should therefore cost less
- Look into patient assistance programs by visiting the drug manufacturer’s website or NeedyMeds.org
- If you are on Social Security, apply for the Extra Help plan
- Contact PanCAN Patient Services for additional resources, to help find assistance programs and to talk through your options
The bottom line?
It is important to discuss with your doctor the appropriate type and dose of pancreatic enzymes during your regular visits.
Good nutritional care improves outcomes and is critical for pancreatic cancer patients’ quality of life. PanCAN strongly recommends that patients have access to pancreatic enzymes and see a registered dietitian.