The ASPERT (Aotearoa Australia Pancreatic Enzyme Replacement Therapy) research group, led by Dr Amanda Landers at the University of Otago, has highlighted the significant underuse of pancreatic enzyme replacement therapy (PERT) for people with pancreatic cancer in Australia and New Zealand.
ASPERT has investigated access, prescribing practices, and patient outcomes related to PERT, a treatment known to improve nutrition, symptom control, and treatment tolerance in those with pancreatic exocrine insufficiency. Despite strong clinical evidence supporting its use, uptake remains inconsistent and below best-practice standards. A 2014 retrospective study found that although over 70% of patients with metastatic pancreatic cancer showed signs of malabsorption, only 21% were prescribed PERT—revealing a critical gap between need and treatment.
A 2016 pilot study confirmed that PERT is well tolerated and significantly improves symptoms and quality of life. In 2021, ASPERT formally launched a trans-Tasman collaborative research program involving clinicians, researchers, dietitians, and consumer advocates. In 2022, the group completed a cross-sectional survey of 334 patients (199 from Australia and 135 from New Zealand). Results showed that only 60% of New Zealanders and 69% of Australians were aware of PERT. Just 18% in NZ and 27% in Australia were receiving guideline-based dosing, yet most who did reported clear symptom relief and improved nutrition.
A parallel clinician survey revealed further challenges: 70% of NZ and 77% of Australian health professionals were unaware of best-practice PERT guidelines. Many under-prescribed the therapy or gave incorrect advice on timing, often without input from a dietitian—highlighting gaps in knowledge and access. In response, ASPERT launched further population-level surveys to map current practices, prescribing patterns, and educational needs. An awareness campaign on social media provides a platform for information and support. The group also advocates for national guidelines, clinician education, and equitable access to specialist dietetic care.
ASPERT is now advancing toward intervention-focused trials to address ongoing gaps in PERT uptake and improve care for pancreatic cancer patients. The research group is always looking for new collaborations and partnerships to further the mission of improving supportive care in pancreatic cancer across Australia and New Zealand.