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Mirza MB, Baechle JJ, Marincola Smith P, Dillhoff M, Poultsides G, Rocha FG, Cho CS, Winslow ER, Fields RC, Maithel SK, Idrees K. Survival disparities in rural versus urban patients with pancreatic neuroendocrine tumor: A multi-institutional study from the US neuroendocrine tumor study group. Am J Surg 2024; 233:125-131. [PMID: 38492993 DOI: 10.1016/j.amjsurg.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Pancreatic Neuroendocrine Tumors (PNETs) are indolent malignancies that often have a prolonged clinical course. This study assesses disparities in outcomes between PNET patients who live in urban (UA) and rural areas (RA). METHODS A retrospective cohort study was performed using the US Neuroendocrine Tumor Study Group database. PNET patients with a home zip code recorded were included and categorized as RA or UA according to the Federal Office of Rural Health Policy. Overall survival (OS) was analyzed by Kaplan-Meier method, log-rank test, and logistical regression. RESULTS Of the 1176 PNET patients in the database, 1126 (96%) had zip code recorded. While 837 (74%) lived in UA, 289 (26%) lived in RA. RA patients had significantly shorter median OS following primary PNET resection (122 vs 149 months, p = 0.01). After controlling for income, local healthcare access, distance from treatment center, ASA class, BMI, and T/N/M stage, living in a RA remained significantly associated with worse OS (HR 1.60, 95%CI 1.08-2.39, p = 0.02). CONCLUSION Rural patients have significantly shorter OS following PNET resection compared to their urban counterparts.
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Affiliation(s)
- Muhammad Bilal Mirza
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jordan J Baechle
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States; School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - Paula Marincola Smith
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary Dillhoff
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | | | - Flavio G Rocha
- Virginia Mason Medical Center, Seattle, WA, United States
| | - Clifford S Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Emily R Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ryan C Fields
- Washington University School of Medicine, St Louis, MO, United States
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
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Proposed Implementation of a Patient-Centered Self-Assessment Tool for Patients with Neuroendocrine Tumors among Academic and Community Practice Sites: The City of Hope Model. J Clin Med 2023; 12:jcm12031229. [PMID: 36769875 PMCID: PMC9917881 DOI: 10.3390/jcm12031229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients' knowledge of their neuroendocrine tumor diagnosis/treatment and facilitate communication with their physician. In this report, we provide a brief overview of patient assessments that have been used for patients with neuroendocrine tumors. We summarize NET VITALS and present a proposed infrastructure for its implementation into standard clinical care in both academic and community practice settings at City of Hope. Incorporating NET VITALS into standard of care treatment for patients with neuroendocrine tumors may improve patients' overall clinical care experience.
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Seo C, Horodniceanu E, Shah R, Goldstein G, Ray D, Bennett B, Phan A, McCarrier K. A qualitative study to understand the experience of somatostatin analog treatments from the perspective of patients with neuroendocrine tumors. Support Care Cancer 2022; 30:6307-6316. [PMID: 35476113 PMCID: PMC9135819 DOI: 10.1007/s00520-022-07054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/07/2022] [Indexed: 12/01/2022]
Abstract
Purpose Neuroendocrine tumors (NETs) negatively impact patients’ quality of life. Octreotide long-acting release (LAR) and lanreotide depot are somatostatin analogs (SSAs) approved to treat NETs. The study objective was to explore SSA treatment experiences and preferences of patients with NETs. Methods Qualitative interviews were conducted in US adults (≥ 21 years) with NETs who had ≥ 6 months’ treatment with each SSA and transitioned from octreotide LAR to lanreotide depot within the previous year. Participants were asked open-ended questions about their experiences with octreotide LAR and lanreotide depot, treatment preferences, and SSA treatment attributes. Results Twenty participants (mean age: 58 years; 90% female; 85% white) completed interviews. The most common reasons for treatment transition were doctor recommendation (70%), treatment not working as expected (55%), and injection type preference (45%). Participants reported 34 unique favorable attributes of SSA treatment and 82 unique unfavorable attributes. Symptom control was the most frequently reported favorable attribute (associated with octreotide LAR by 60% of participants and lanreotide depot by 65%). Painful injection (65%) was most frequently cited unfavorable attribute for octreotide LAR and injection experience dependent on administrator (35%) for lanreotide depot. The three SSA treatment attributes rated as most important were side effects, symptom control, and ability to stabilize tumor. Conclusion Our qualitative data provide valuable insight into the treatment attributes that patients with NETs consider important when making SSA treatment decisions. Factors related to injection administration, side effects, and symptom control are important to patients and should be included in patient-provider communications in clinical contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07054-x.
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Affiliation(s)
- Caroline Seo
- Pharmerit-an OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, USA
| | - Erica Horodniceanu
- Pharmerit-an OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, USA
| | - Rachel Shah
- Pharmerit-an OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, USA
| | | | - David Ray
- Ipsen Biopharmaceuticals, Cambridge, MA, USA
| | | | - Alexandria Phan
- UT Health East Texas North Campus MD Anderson Cancer Center, Tyler, TX, USA
| | - Kelly McCarrier
- Pharmerit-an OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, USA.
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Harrow B, Fagnani F, Nevoret C, Truong-Thanh XM, de Zélicourt M, de Mestier L. Patterns of Use and Clinical Outcomes with Long-Acting Somatostatin Analogues for Neuroendocrine Tumors: A Nationwide French Retrospective Cohort Study in the Real-Life Setting. Adv Ther 2022; 39:1754-1771. [PMID: 35190997 PMCID: PMC8989892 DOI: 10.1007/s12325-022-02060-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
Introduction Long-acting somatostatin analogues such as lanreotide autogel (LAN) and octreotide long-acting release (OCT) are recommended as first-line treatment for patients with neuroendocrine tumors (NETs). However, only few real-world studies have compared the two medications. This retrospective, observational cohort study used a French claims database to compare patterns of use with LAN vs. OCT in patients with NETs. Methods Data on LAN and OCT patterns of use were obtained retrospectively from the National System of Health Data (SNDS), a national French claims database. Patients 18 years of age or older who initiated treatment for NETs between 2009 and 2016, and who received at least six subsequent dispensings of first-line LAN or OCT during the first year of treatment, were included. A subgroup analysis was performed on patients with gastroenteropancreatic (GEP)-NETs. Results Patients receiving LAN (n = 2327) vs. OCT (n = 2090) had greater median treatment duration (31.8 months vs. 22.1 months, respectively; p < 0.0001; log-rank test) and were less likely to discontinue treatment; adjusted hazard ratio (HR) 0.74 (95% confidence interval [CI] 0.69–0.80). In year 1, a significantly lower percentage of patients receiving LAN vs. OCT switched treatments (10.4% vs. 22.2%, respectively; p < 0.0001), received an average monthly dose per trimester above recommended dose (3.0% vs. 7.3%, respectively; p < 0.0001), and used rescue medication (3.1% vs. 10.0%, respectively; p < 0.0001). Dispensing of pancreatic enzymes was significantly higher in patients receiving LAN than OCT (16.4% vs. 13.9%, respectively). In the subgroup of patients with GEP-NETs, those receiving LAN (n = 1478) vs. OCT (n = 1278) had greater treatment duration and less treatment discontinuation, switching, dosage above the recommended dose, and rescue medication use, but no significant difference in dispensing of pancreatic enzymes or time to second-line treatment. Conclusion These real-world data suggest potential clinical and economic advantages of LAN over OCT in the management of patients with NETs in the French population. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02060-1.
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Affiliation(s)
| | | | | | | | | | - Louis de Mestier
- Department of Gastroenterology-Pancreatology, Beaujon Hospital (APHP), Université de Paris, 100 bd du Général Leclerc, 92100, Clichy, France.
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Michael M, Chantrill L, Price T, Chan DL, Wakelin K, Cummins M. Real-world management and patient perspectives on QOL with neuroendocrine tumors: An ANZ perspective. Asia Pac J Clin Oncol 2021; 17 Suppl 2:3-10. [PMID: 33851520 DOI: 10.1111/ajco.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Michael
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lorraine Chantrill
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Timothy Price
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - David L Chan
- Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Wakelin
- NeuroEndocrine Cancer Australia, Melbourne, Victoria, Australia
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Kolarova T, Bouvier C. The Role of Patient Support Groups in Neuroendocrine Neoplasms. Curr Oncol Rep 2021; 23:53. [PMID: 33754245 PMCID: PMC7985052 DOI: 10.1007/s11912-021-01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to establish the role patient support groups play in NENs. RECENT FINDINGS Published data on the role and work done by these groups is extremely sparse, so the review references publications in the wider cancer advocacy context. For the purposes of the review, a survey was carried out among the members of a global umbrella organization to ascertain the level of activities undertaken in support of the NEN patient community. The concept of "support groups" has changed significantly, as these groups have evolved from patient peer-to-peer support provision to a strategic focus on improving awareness and education among all stakeholders, generating patient evidence to influence policies for access to optimal diagnostics, treatment, and care, and setting the research agenda. Today, NEN patient organizations have an instrumental role of catalysts of change across the healthcare spectrum-especially relevant in a setting of less common and not well-understood diseases, where clear pathways and guidelines are still a challenge.
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Wakelin K. Patient reported experience of the burden of neuroendocrine tumors and impact of eSHINE Patient Support Program on patient quality of life. Asia Pac J Clin Oncol 2020; 16 Suppl 7:3-8. [PMID: 33145888 DOI: 10.1111/ajco.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Neuroendocrine tumors (NETs) are an uncommon cancer and difficult to diagnose and treat. Treatment is complicated by debilitating side effects, impacting quality of life. This Australia-wide survey aimed to increase our understanding of the impact and burden of NETs on patient quality of life (QoL) and to assess the benefit of a patient support program (eSHINE). METHOD Consented patients from the eSHINE mailing list (n = 267) were invited to participate in an electronic self-reported survey comprising 29 questions on clinical characteristics, diagnosis, sociodemographics, impact of living with NETs and benefits of a patient support program. No formal sample size was calculated. All analyses were descriptive. RESULTS A total of 144 participants (54%) responded. A total of 129 (48%) completed all questions. Approximately half of respondents were female, from metropolitan and rural areas, aged over 65 years and had a primary diagnosis of gastrointestinal NETs. Fifty-eight percent had been diagnosed over 5 years ago. Twenty-seven percent reported seeing four or more healthcare professionals prior to being diagnosed. Living with NETs had a large impact on patients' QoL. 83.5% reported fatigue, 76% felt their emotional health was impacted by NETs and 75% reported reduced ability to participate in leisure activities. Access to a supportive network to manage and treat NETs was extremely important to participants. Eighty-five percent of respondents reported the eSHINE program had a positive impact on their QoL. CONCLUSION Patients value support from healthcare professionals and patient support programs such as eSHINE in managing NETs. The eSHINE Patient Support Program has a positive impact on patient QoL.
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Bai J, Tian Y, Liu F, Li X, Shao Y, Lu X, Wang J, Zhu G, Xue B, Liu M, Hu P, He N, Tang Q. Octreotide-Conjugated Core-Cross-Linked Micelles with pH/Redox Responsivity Loaded with Etoposide for Neuroendocrine Neoplasms Therapy and Bioimaging with Photoquenching Resistance. ACS APPLIED MATERIALS & INTERFACES 2019; 11:18111-18122. [PMID: 31006230 DOI: 10.1021/acsami.9b01827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The study of multifunctional polymer micelles combined with chemotherapy due to reduced systemic toxicity and enhanced efficacy has attracted intensive attention. Herein, a multifunctional core-cross-linked hybrid micelle system based on mPEG- b-PGu(BA-TPE) and OCT-PEG- b-PGu(DA-TPE) with pH- and redox-triggered drug release and aggregation-induced emission (AIE) active imaging has been developed for active targeting of neuroendocrine neoplasms (NENs), especially neuroendocrine carcinomas (NECs) with poor prognosis. These micelles showed excellent biocompatibility and stability. After the formation of borate ester bonds, core-cross-linked micelles (CCLMs) showed enhanced emission properties. In addition, etoposide (ETO), one of the most important anticancer drugs of NECs, was loaded into the hydrophobic core of micelles by self-assembly with an average diameter of 274.6 nm and spherical morphology. Octreotide (OCT) conjugated onto the micelles enhanced cellular uptake by receptor-mediated endocytosis. ETO-loaded micelles demonstrated the dual-responsive triggered intracellular drug release and great tumor suppression ability in vitro. Compared with free ETO, ETO-loaded CCLMs exhibited a considerable antitumor effect and significantly reduced side effects. Considering the active tumor targeting, dual-responsive drug release and the AIE effect, the polymer micelle system will be a potential candidate for diagnosis and oncotherapy of NENs.
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Affiliation(s)
- Jianan Bai
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Ye Tian
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Fangzhou Liu
- Department of Head & Neck Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research , The Affiliated Cancer Hospital of Nanjing Medical University , Nanjing 210029 , China
| | - Xiaolin Li
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Yun Shao
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Xintong Lu
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Jintian Wang
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Guoqin Zhu
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Bingyan Xue
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Min Liu
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Ping Hu
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Na He
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
| | - Qiyun Tang
- Department of Geriatric Gastroenterology , The First Affiliated Hospital with Nanjing Medical University , Nanjing 210029 , China
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