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Neuroendocrinology. 2018;107(4):366-374. doi: 10.1159/000494293. Epub 2018 Oct 5.

Health-Related Quality of Life in Patients with Small Intestine Neuroendocrine Tumors.

Author information

1
Endocrinology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
2
Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
3
Department of Public Health, University of Helsinki, Helsinki, Finland.
4
Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
5
Group Administration, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
6
Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
7
Endocrine Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
8
Endocrinology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finlandcamilla.schalin-jantti@hus.fi.

Abstract

BACKGROUND:

The prevalence of small intestine neuroendocrine tumors (SI-NETs) is increasing. Disease progression is often slow and treatment options and long-term survival rates have improved, but little is known about health-related quality of life (HRQoL) in these patients.

OBJECTIVE:

To assess HRQoL and its predictors in SI-NET patients receiving contemporary treatments.

METHODS:

We measured HRQoL with 15D and SF-36 questionnaires in 134 SI-NET patients and compared the 15D results to those of an age- and gender-standardized sample of the general population (n = 1,153). In the patients, we studied the impact of treatments, Ki-67, liver metastases, circulating tumor markers, comorbidities, and/or socioeconomic factors on HRQoL with linear regression analysis.

RESULTS:

The mean disease duration of the patients was 81 (4-468) months, 91% had metastatic disease, and 79% received somatostatin analog treatment. Hepatic tumor load was 0% in 44.8%, < 10-25% in 44.0%, and > 25% in 11.2%, respectively. Mean fP-CgA and S-5HIAA concentrations were 15 (1.3-250) and 344 (24-7,470) nmol/L, respectively. Overall, HRQoL was significantly impaired in patients compared to controls (15D score 0.864 ± 0.105 vs. 0.905 ± 0.028, p < 0.001). SI-NET patients scored worse on 9 of 15 dimensions: sleep, excretion (i.e., bladder and bowel function), depression, distress, vitality, sexual activity (p < 0.001), breathing, usual activities, and discomfort and symptoms (p < 0.01-0.05). SF-36 scores were impaired and highly correlated with 15D scores (p < 0.001). HRQoL was impaired in patients with (n = 85) compared to patients without (n = 49) impaired excretion (0.828 vs. 0.933, p < 0.001). In the patient group, number of medications predicted impaired HRQoL.

CONCLUSIONS:

Despite contemporary treatments, SI-NET patients have severely impaired HRQoL, including diarrhea, sleep, depression, vitality, and sexual activity.

KEYWORDS:

5-Hydroxyindoleacetic acid; Carcinoid syndrome; Chromogranin A; Depression; Diarrhea; Health-related quality of life; Small intestine neuroendocrine tumor

PMID:
30293074
DOI:
10.1159/000494293

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