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Milanetto AC, Armellin C, Brigiari G, Lorenzoni G, Pasquali C. Younger Age and Parenchyma-Sparing Surgery Positively Affected Long-Term Health-Related Quality of Life after Surgery for Pancreatic Neuroendocrine Neoplasms. J Clin Med 2023; 12:6529. [PMID: 37892667 PMCID: PMC10607516 DOI: 10.3390/jcm12206529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Patients with pancreatic Neuroendocrine Neoplasms (PanNENs) often have a long overall survival. We evaluated determinants of quality of life (QoL) after surgery for PanNENs. (2) Methods: Patients operated on for a PanNEN in our center (1990-2021) received three EORTC QoL questionnaires (QLQ-C30, QLQ-GI.NET21, QLQ-PAN26). Six domains were selected as outcome variables (global QoL, physical function -PF, social function -SF, disease-related worries -DRWs, pain, upper-gastrointestinal (GI) symptoms) and evaluated in relation to the clinical variables. Statistical analysis was performed using R software v 4.2.2. (3) Results: One hundred and four patients enrolled showed a good global QoL (median 83.3). Old age was a determinant of worse global QoL (p 0.006) and worse PF (p 0.003). Multiple comorbidities (p 0.002) and old age (p 0.034) were associated with pain, while male gender was related to better PF (p 0.007) and less pain (p 0.012). Patients who had undergone parenchyma-sparing surgery demonstrated better PF (p 0.037), better SF (p 0.012), and less upper-GI symptoms (p 0.047). At multivariable analysis, age (p 0.005) and type of surgery (p 0.028) were confirmed as determinants of global QoL. (4) Conclusions: In patients operated on for a PanNEN, a good HRQoL is generally reported; notably, younger age and parenchyma-sparing surgery seem to positively affect HRQoL.
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Affiliation(s)
- Anna Caterina Milanetto
- Chirurgia Generale 3, Pancreatic and Digestive Endocrine Surgery Research Group, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Claudia Armellin
- Chirurgia Generale 3, Pancreatic and Digestive Endocrine Surgery Research Group, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Gloria Brigiari
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Claudio Pasquali
- Chirurgia Generale 3, Pancreatic and Digestive Endocrine Surgery Research Group, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
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Naraev BG, Mailman J, Halfdanarson TR, Soares HP, Mittra ES, Hallet J. Consideration of quality-of-life in the treatment decision-making for patients with advanced gastroenteropancreatic neuroendocrine tumors. Expert Rev Anticancer Ther 2023; 23:601-615. [PMID: 37158050 DOI: 10.1080/14737140.2023.2207829] [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: 05/10/2023]
Abstract
INTRODUCTION Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a complex and heterogenous family of solid malignancies that originate from neuroendocrine tissue in the gastrointestinal tract or pancreas. Most patients diagnosed with GEP-NETs present with advanced or metastatic disease, and quality of life (QoL) is often an important priority when selecting treatments for these patients. Patients with advanced GEP-NETs often experience a substantial and persistent symptom burden that undermines their QoL. Addressing a patient's individual symptoms through judicious selection of treatment may improve QoL. AREAS COVERED The objectives of this narrative review are to summarize the impact of advanced GEP-NETs on patient QoL, assess the potential value of current treatments for maintaining or improving patient QoL, and offer a clinical framework for how these QoL data can be translated to inform clinical decision-making for patients with advanced GEP-NETs. EXPERT OPINION Patients with advanced GEP-NETs experience a significant and persistent symptom burden that impacts their daily lifestyle, activities, work life, and financial health, leading to erosion of their QoL. Ongoing and future studies incorporating longitudinal QoL assessments and head-to-head treatment evaluations will further inform the incorporation of QoL into clinical decision-making.
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Affiliation(s)
- Boris G Naraev
- Anderson Family Cancer Institute, 1240 S Old Dixie Highway, Jupiter, Florida33458, USA
| | - Josh Mailman
- NorCal CarciNET Community, 946 N Ripon Rd, Ripon, CA 95366, USA
| | - Thorvardur R Halfdanarson
- Division of Medical Oncology, Mayo Clinic Cancer Center, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Heloisa P Soares
- Huntsman Cancer Institute at the University of Utah, 1950 Circle of Hope Dr. Salt Lake City, Utah 84112, USA
| | - Erik S Mittra
- Division of Nuclear Medicine and Molecular Imaging, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon97239, USA
| | - Julie Hallet
- Department of Surgery, University of Toronto, 27 King's College Cir, Toronto, Ontario M5S, Canada; Susan Leslie Clinic for Neuroendocrine Tumors - Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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Staal FC, Taghavi M, Hong EK, Tissier R, van Treijen M, Heeres BC, van der Zee D, Tesselaar ME, Beets-Tan RG, Maas M. CT-based radiomics to distinguish progressive from stable neuroendocrine liver metastases treated with somatostatin analogues: an explorative study. Acta Radiol 2023; 64:1062-1070. [PMID: 35702011 DOI: 10.1177/02841851221106598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate response evaluation in patients with neuroendocrine liver metastases (NELM) remains a challenge. Radiomics has shown promising results regarding response assessment. PURPOSE To differentiate progressive (PD) from stable disease (SD) with radiomics in patients with NELM undergoing somatostatin analogue (SSA) treatment. MATERIAL AND METHODS A total of 46 patients with histologically confirmed gastroenteropancreatic neuroendocrine tumors (GEP-NET) with ≥1 NELM and ≥2 computed tomography (CT) scans were included. Response was assessed with Response Evaluation Criteria in Solid Tumors (RECIST1.1). Hepatic target lesions were manually delineated and analyzed with radiomics. Radiomics features were extracted from each NELM on both arterial-phase (AP) and portal-venous-phase (PVP) CT. Multiple instance learning with regularized logistic regression via LASSO penalization (with threefold cross-validation) was used to classify response. Three models were computed: (i) AP model; (ii) PVP model; and (iii) AP + PVP model for a lesion-based and patient-based outcome. Next, clinical features were added to each model. RESULTS In total, 19 (40%) patients had PD. Median follow-up was 13 months (range 1-50 months). Radiomics models could not accurately classify response (area under the curve 0.44-0.60). Adding clinical variables to the radiomics models did not significantly improve the performance of any model. CONCLUSION Radiomics features were not able to accurately classify response of NELM on surveillance CT scans during SSA treatment.
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Affiliation(s)
- Femke Cr Staal
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Taghavi
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eun K Hong
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, 26725Seoul National University Hospital, Seoul, Republic of Korea
| | - Renaud Tissier
- Biostatistics Center, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mark van Treijen
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Endocrine Oncology, 8124University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Birthe C Heeres
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Margot Et Tesselaar
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Oncology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina Gh Beets-Tan
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Monique Maas
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Hummelshøj NE, Gronbaek H, Bager P, Tabaksblat E, Dam G. Fatigue and quality of life in patients with neuroendocrine neoplasia. Scand J Gastroenterol 2023; 58:45-53. [PMID: 35850607 DOI: 10.1080/00365521.2022.2100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Neuroendocrine Neoplasms (NEN) are rare tumours arising in the gastro-intestinal tract or lungs. Poor health related quality of life (HRQoL) is associated with the carcinoid syndrome (CS), but fatigue is also important. We aimed to quantify HRQoL and fatigue in out-patients with NEN. METHODS In a cross-sectional study, we included 231 patients with NEN (G1-G3). We used pre-validated questionnaires MFI-20, EQ-5D-5L and 85% responded. We collected clinical, biochemical, imaging, and pathology data from Electronic Patient files. Normative values for fatigue and HRQoL were derived from background populations. RESULTS Median age was 68 years (range 21-91) and 52% were male. Patients with NEN reported more fatigue and worse HRQoL compared to the background population (p < .05). Cured patients reported higher HRQoL than patients with current disease, and patients with high grade neoplasms (G2-G3) reported more anxiety and depression compared to patients with low grade G1 disease (p < .05). The CS resulted in a 9% relative loss in Quality Adjusted Life Years compared to patients without CS. (p < .05). More than 50% of patients with CS reported problems with usual activities, pain/discomfort, and anxiety/depression. Overall, 36% of patients with NEN were fatigued and 92% of these had psychological fatigue. Younger patients (<65 years) experienced more fatigue than older patients (p < .05). CONCLUSION Patients with NEN report significantly lower HRQoL and more fatigue compared to the background population. Especially, patients with CS had pain, discomfort, anxiety, and depression and a relative reduction in HRQoL. However, compared to other cancer types, patients with NEN experience less fatigue.
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Affiliation(s)
| | - Henning Gronbaek
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Palle Bager
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Gitte Dam
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ohlsson H, Gålne A, Trägårdh E, Malmström M, Sundlöv A, Almquist M. Relationship between somatostatin receptor expressing tumour volume and health-related quality of life in patients with metastatic GEP-NET. J Neuroendocrinol 2022; 34:e13139. [PMID: 35488399 PMCID: PMC9285792 DOI: 10.1111/jne.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/05/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
For patients with gastroenteropancreatic neuroendocrine tumours (GEP-NET), health-related quality of life (HRQoL) is important. Meanwhile, whether tumour volume is associated with HRQoL is unknown. Hence, the aim of this study was to assess if total somatostatin receptor expressing tumour volume is correlated with HRQoL in patients with metastatic GEP-NET. Some 71 patients were included in the study. HRQoL and NET-specific symptoms were assessed with EORTC QLQ-C30 and EORTC GI.NET21. A summary score was calculated from the output of the QLQ-C30. Total somatostatin receptor expressing tumour volume was retrospectively evaluated on somatostatin receptor imaging with positron emission tomography-computed tomography (68 Ga-DOTA-TATE/TOC PET-CT) in each patient. Simple and multiple linear regression were used to evaluate the correlation between tumour volume and HRQoL, controlling for potential confounders. No correlation was found between total somatostatin receptor expressing tumour volume and QLQ-C30 summary score. Weak positive correlations were found between total tumour volume and the specific symptoms dyspnoea, diarrhoea and flushing. To the best of our knowledge, this is the first study to evaluate the association between total somatostatin expressing tumour volume and HRQoL. Our results indicate that, while tumour volume is weakly associated with symptom severity of the carcinoid syndrome, other factors might impact more on overall HRQoL.
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Affiliation(s)
- Håkan Ohlsson
- Department of SurgeryYstad HospitalYstadSweden
- Institute of Clinical SciencesLund UniversityLundSweden
| | - Anni Gålne
- Department of Medical Imaging and PhysiologySkåne University HospitalLundSweden
- Department of Translational MedicineLund UniversityMalmöSweden
| | - Elin Trägårdh
- Department of Medical Imaging and PhysiologySkåne University HospitalLundSweden
- Department of Translational Medicine and Wallenberg Centre for Molecular MedicineLund UniversityMalmöSweden
| | - Marlene Malmström
- Department of Surgery and GastroenterologySkåne University HospitalLundSweden
- Department of Health SciencesLund UniversityLundSweden
| | - Anna Sundlöv
- Division of OncologySkåne University HospitalLundSweden
- Department of Clinical SciencesLund UniversityLundSweden
| | - Martin Almquist
- Institute of Clinical SciencesLund UniversityLundSweden
- Endocrine‐Sarcoma Unit, Department of SurgerySkåne University HospitalLundSweden
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Li J, Cheng Y, Bai C, Xu J, Shen L, Li J, Zhou Z, Li Z, Chi Y, Yu X, Li E, Xu N, Liu T, Lou W, Bai Y, Yuan X, Wang X, Yuan Y, Chen J, Guan S, Fan S, Su W. Health-related quality of life in patients with advanced well-differentiated pancreatic and extrapancreatic neuroendocrine tumors treated with surufatinib versus placebo: Results from two randomized, double-blind, phase III trials (SANET-p and SANET-ep). Eur J Cancer 2022; 169:1-9. [PMID: 35489301 DOI: 10.1016/j.ejca.2022.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/08/2023]
Abstract
AIM To investigate the health-related quality of life (HRQoL) of patients who had neuroendocrine tumors (NETs) from SANET trials. METHODS Eligible patients were randomized in a 2:1 ratio to receive surufatinib or placebo. HRQoL questionnaires, including the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-G.I.NET21, were collected. The prespecified HRQoL outcome was the mean change of scores from baseline to the last available visit for each domain. Time until definitive deterioration (TUDD) was defined as the time from randomization to deterioration of ≥10 points from baseline in domain score, disease progression, or death. RESULTS 370 patients were enrolled and randomly assigned to surufatinib (n = 242) or placebo (n = 128). No significant difference in mean scores change from baseline to the last available visit was observed for QLQ-C30 and QLQ- G.I.NET21 domains, with the exception of diarrhea. The mean score of diarrhea increased 11.7 points from baseline in the surufatinib arm and decreased 1.2 points in the placebo arm, and the between-group difference was 12.9 points. Compared with placebo, surufatinib treated patients had a significantly longer TUDD for dyspnea (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.39-0.86; P = 0.0058) and a significantly shorter TUDD for diarrhea (HR 2.91; 95% CI, 1.66-5.10; P < 0.0001). There were no significant differences in TUDD for the remaining domains of QLQ-C30 and G.I.NET-21. CONCLUSIONS HRQoL was similar in patients treated with surufatinib and placebo except for diarrhea. The preservation of HRQoL supports surufatinib as a treatment option fo r NETs. CLINICAL TRIAL INFORMATION ClinicalTrials.gov: NCT02589821, NCT02588170.
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Affiliation(s)
- Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejuan Cheng
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianming Xu
- Department of Gastrointestinal Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
| | - Jie Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiping Li
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yihebali Chi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianjun Yu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Enxiao Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nong Xu
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Tianshu Liu
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuxian Bai
- Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuwen Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan
| | - Ying Yuan
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Chen
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing, China
| | - Sha Guan
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
| | - Songhua Fan
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
| | - Weiguo Su
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
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Begum N, Hunold H, Gerdes B, Keck T, Waldmann A. Anxiety, Depression and Quality of Life in Patients with Neuroendocrine Neoplasia After Surgery. World J Surg 2022; 46:1408-1419. [PMID: 35194674 PMCID: PMC9054889 DOI: 10.1007/s00268-022-06479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neuroendocrine neoplasia (NEN) are rare and complex, with surgery as key therapy even in cases with metastasis. Little is known regarding the quality of life, prevalence of depression, anxiety and the impact of surgery. METHODS This prospective, follow-up study included 90 consecutively recruited patients with NEN after surgery in a university hospital. The EORTC QLQ-C30, EORTC QLQ-GI-NET.21, and Hospital Anxiety and Depression Scale and a hospital specific questionnaire were completed during follow-up after 3 to 5 years (t1-t5). RESULTS Mean age was 54 (SD 15) years, 13% had secondary malignancies and 11% had psychiatric diagnoses (depression n = 8, schizophrenia n = 2) pre-existent. Critical life events occurred in 51% within 5 years before diagnosis. Surgery was done in curative intention in 82% and R0-resection rate was 90%. The median survival was 25.3 years. The 10-year survival rate was 87%, 98%, 95% and 26% for all patients (n = 90), stage I/II (n = 45), stage III (n = 25) and stage IV (n = 20), respectively (p < .001). Anxiety score was pathological in 30% after 1 year (t1) and in 10% after 5 years, depression score in 25% (t1) and 30% (t5). Fatigue and muscle/body pain were elevated symptoms with > 50 and 40 points 3 years after surgery. CONCLUSION Depression rate remains high whereas anxiety declines over time. Fatigue and muscle/body pain were identified as relevantly elevated after surgery. Systematic screening and supportive therapy should be implemented during follow-up after surgery.
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Affiliation(s)
- Nehara Begum
- Department of General-, Visceral-, Thoracic- and Endocrine Surgery, Johannes Wesling Klinikum Minden, University Hospital of the Ruhr-University Bochum(RUB), Hans-Nolte Str. 1, 32429, Minden, Germany. .,Department for General Surgery, University Hospital Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Hannah Hunold
- Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
| | - Berthold Gerdes
- Department of General-, Visceral-, Thoracic- and Endocrine Surgery, Johannes Wesling Klinikum Minden, University Hospital of the Ruhr-University Bochum(RUB), Hans-Nolte Str. 1, 32429, Minden, Germany
| | - Tobias Keck
- Department for General Surgery, University Hospital Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
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Ronde EM, Heidsma CM, Eskes AM, Schopman JE, Nieveen van Dijkum EJM. Health-related quality of life and treatment effects in patients with well-differentiated gastroenteropancreatic neuroendocrine neoplasms: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2021; 30:e13504. [PMID: 34462979 PMCID: PMC9286581 DOI: 10.1111/ecc.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Introduction Gastroenteropancreatic neuroendocrine neoplasms (GEPNENs) are often diagnosed in an advanced stage. As the optimal sequence of therapy remains largely unclear, all treatment‐related outcomes, including health‐related quality of life (HRQoL) prospects, should be assessed according to patients' preferences. Methods A targeted search was performed in PubMed and EMBASE to identify studies on treatment effect and HRQoL, measured using the EORTC QLQ‐C30 tool, in patients with advanced, well‐differentiated GEPNENs. Study quality was assessed, and meta‐analyses were performed for global health status/QOL and tumour response. Results The search yielded 1,322 records, and 20 studies were included, examining somatostatin analogues (SSA), peptide receptor radionuclide therapies (PRRT), chemotherapy, SSA‐based combination therapies, and targeted therapies. Global HRQoL was stable, and rates for disease stabilisation were moderate to high across all treatments. Meta‐analyses for global health status/QOL after SSA treatment were not significant (mean difference: –0.3 [95% CI: −1.3 to 0.7]). The highest pooled overall tumour response rate was 33% (95% CI: 24–45%) for PRRT. The highest pooled clinical benefit rate was 94% (95% CI: 65–99%) for chemotherapy. Conclusion All treatments appeared beneficial for disease stabilisation while maintaining stable global health status/QOL. High‐quality HRQoL reporting was lacking. HRQoL should be a central outcome next to well‐established outcomes.
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Affiliation(s)
- Elsa M Ronde
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte M Heidsma
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josefine E Schopman
- Department of Medical Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Benavent M, Sastre J, Escobar IG, Segura A, Capdevila J, Carmona A, Sevilla I, Alonso T, Crespo G, García L, Canal N, de la Cruz G, Gallego J. Physician-perceived utility of the EORTC QLQ-GINET21 questionnaire in the treatment of patients with gastrointestinal neuroendocrine tumours: a multicentre, cross-sectional survey (QUALINETS). Health Qual Life Outcomes 2021; 19:38. [PMID: 33516211 PMCID: PMC7847563 DOI: 10.1186/s12955-021-01688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background and objective Patient-reported outcome measures can provide clinicians with valuable information to improve doctor-patient communication and inform clinical decision-making. The aim of this study was to evaluate the physician-perceived utility of the QLQ-GINET21 in routine clinical practice in patients with gastrointestinal neuroendocrine tumours (GI-NETs). Secondary aims were to explore the patient, clinician, and/or centre-related variables potentially associated with perceived clinical utility. Methods Non-interventional, cross-sectional, multicentre study conducted at 34 hospitals in Spain and Portugal (NCT02853422). Patients diagnosed with GI-NETs completed two health-related quality of life (HRQoL) questionnaires (QLQ-C30, QLQ-GINET21) during a single routine visit. Physicians completed a 14-item ad hoc survey to rate the clinical utility of QLQ-GINET21 on three dimensions: 1)therapeutic and clinical decision-making, 2)doctor-patient communication, 3)questionnaire characteristics. Results A total of 199 patients at 34 centres were enrolled by 36 participating clinicians. The highest rated dimension on the QLQ-GINET21 was questionnaire characteristics (86.9% of responses indicating “high utility”), followed by doctor-patient communication (74.4%), and therapeutic and clinical decision-making (65.8%). One physician-related variable (GI-NET patient volume > 30 patients/year) was associated with high clinical utility and two variables (older age/less experience treating GI-NETs) with low clinical utility. Conclusions Clinician-perceived clinical utility of QLQ-GINET21 is high. Clinicians valued the instruments’ capacity to provide a better understanding of patient perspectives and to identify the factors that had the largest influence on patient HRQoL.
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Affiliation(s)
- Marta Benavent
- Virgen Del Rocío University Hospital, Biomedicine Institut Biomedicina of Sevilla (IBIS), Av. Manuel Siurot, S/n, 41013, Sevilla, Spain.
| | - Javier Sastre
- San Carlos Clinic Hospital, San Carlos Hospital Research Institute (IdISSC), Madrid, Spain
| | | | - Angel Segura
- Politécnico La Fe University Hospital, Valencia, Spain
| | - Jaume Capdevila
- Teknon Oncologic Institut (IOT), Teknon Medical Center, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Isabel Sevilla
- Clinical and Translational Research in Cancer, Biomedical Research Institut of Malaga (IBIMA), Regional University Hospital and Virgen de la Victoria University Hospital of Málaga, Málaga, Spain
| | | | | | | | - Neus Canal
- IQVIA Information S.A., Barcelona, Spain
| | | | - Javier Gallego
- Hospital General Universitario de Elche, Elche, Alicante, Spain
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