Patient-reported outcomes in subjects with neuroendocrine tumors of the pancreas

Table 1 Demographic and clinical characteristics of the 44 patients who completed the questionnaires (mean ± SD)

	n (%)
Sex
Males	18 (40.9)
Females	26 (59.1)
Age at interview (yr)	61.0 ± 9.8
Disease duration (yr)	5.8 ± 5.4
Body mass index (kg/m2)	25.9 ± 4.3
Marital status
Single/Widowed/Divorced	10 (22.7)
Married	34 (77.3)
Diploma
Elementary school	11 (25.0)
Middle school	18 (40.9)
High school	10 (22.7)
University degree	5 (11.4)
Job
Current workers	32 (72.7)
Managers	6
Employees	16
Industrial workers	3
Housewives	7
Retired	12 (27.3)
Alcohol habit
Alcohol drinkers	18 (40.9)
Current drinkers	14
Drinking duration (yr)	40.2 ± 12.5
Smoking habit
Smokers	20 (45.5)
Actual smokers	5
No. of cigarettes smoked per day	10.6 ± 5.9
Smoking duration (yr)	28.7 ± 13.3
Comorbidities	30 (68.2)
Non disease specific drugs	35 (79.5)
Previous surgery not due to neuroendocrine tumors	33 (77.0)
Surgery due to pancreatic neuroendocrine tumors	35 (79.5)
Pancreatic head resection	8
Distal pancreatectomy	20
Total pancreatectomy	2
Enucleation	5
Status of neuroendocrine tumors
Disease free	25 (56.8)
Lymph node involvement/liver metastases	19 (43.2)
Specific drugs and treatment
No drugs	30 (68.2)
Somatostatin analogues alone	9 (20.5)
Somatostatin analogues plus radiometabolic therapy	5 (11.4)
Pain in the month prior to complete the questionnaire	17 (38.6)
Dyspepsia	24 (54.5)
Diabetes	12 (27.3)

Data are reported as absolute and relative frequencies or mean ± SD.

Table 2 Effects of neuroendocrine tumors of the pancreas on the SF-12 physical (PCS) and mental (MCS) component summaries estimated by means of three-way ANOVA adjusted for age (increasing trend among the age classes) and gender

	PCS		MCS
	Effects (95% CI)	P value	Effects (95% CI)	P value
Overall effects of the disease (patients vs normative group)	-1.16 (-5.66 to 3.34)	0.610	-5.32 (-10.30 to -0.35)	0.036
Effects of the disease within males	-1.17 (-8.01 to 5.68)	0.735	-6.12 (-13.69 to 1.45)	0.112
Effects of the disease within females	-1.15 (-6.99 to 4.69)	0.697	-4.53 (-10.99 to 1.93)	0.167
Interaction between the effects of the disease and gender (males vs females)	-0.02 (-9.02 to 8.97)	0.996	-1.59 (-11.54 to 8.37)	0.752
Interaction between the effects of the disease and age	3.32 (-6.96 to 13.60)	0.522	9.54 (-1.84 to 20.92)	0.099
Interaction between the effects of the disease and age within males	4.10 (-11.88 to 20.09)	0.611	9.24 (-8.44 to 26.93)	0.301
Interaction between the effects of the disease and age within females	2.54 (-10.39 to 15.48)	0.697	9.84 (-4.47 to 24.15)	0.175
Interaction between the effects of the disease and age and gender	1.56 (-19.00 to 22.12)	0.880	-0.59 (-23.35 to 22.17)	0.959

95% CI: 95% confidence interval.

Table 3 Effects of neuroendocrine tumors of the pancreas on the STAI Y-1 (anxiety state) and Y-2 (anxiety trait) estimated by means of three-way ANOVA adjusted for age (increasing trend among the age classes) and gender

	STAI anxiety state (Y-1)		STAI anxiety trait (Y-2)
	Effects (95% CI)	P value	Effects (95% CI)	P value
Overall effects of the disease (patients vs normative group)	-5.16 (-12.56 to 2.23)	0.169	0.77 (-5.84 to 7.39)	0.817
Effects of the disease within males	-4.66 (-16.98 to 7.67)	0.454	-0.48 (-11.50 to 10.54)	0.932
Effects of the disease within females	-5.66 (-13.84 to 2.51)	0.172	2.02 (-5.29 to 9.33)	0.584
Interaction between the effects of the disease and gender (males vs females)	1.00 (-13.79 to 15.79)	0.893	-2.50 (-15.72 to 10.73)	0.708
Interaction between the effects of the disease and age	7.69 (-7.10 to 22.48)	0.304	-2.58 (-15.81 to 10.64)	0.698
Interaction between the effects of the disease and age within males	5.30 (-19.35 to 29.95)	0.670	-0.05 (-22.09 to 21.99)	0.996
Interaction between the effects of the disease and age within females	10.07 (-6.28 to 26.42)	0.224	-5.12 (-19.74 to 9.51)	0.488
Interaction between the effects of the disease and age and gender	-4.77 (-34.35 to 24.81)	0.749	5.06 (-21.39 to 31.51)	0.704

Table 4 Relationships between SF-12 and STAI scores, and GHQ-12 and BDI-II scores in the 44 patients with neuroendocrine tumors of the pancreas (mean ± SD)

	SF-12		STAI
	PCS	MCS	Anxiety state (Y-1)	Anxiety trait (Y-2)
GHQ-121
Subjects without non-psychotic psychiatric disorders (score ≤ 4, n = 33)	46.1 ± 9.8	44.4 ± 11.8	42.3 ± 10.9	39.1 ± 10.1
Subjects with psychotic psychiatric disorders (score > 4, n = 11)	40.6 ± 13.9	36.1 ± 15.0	50.7 ± 13.9	49.6 ± 10.3
P value	0.156	0.066	0.043	0.005
BDI-II2
Absence of depression (score ≤ 13, n = 27)	48.2 ± 8.8	47.3 ± 10.3	39.1 ± 9.1	36.1 ± 8.1
Mild depression (score 14-19, n = 9)	40.0 ± 11.8	40.1 ± 14.8	44.2 ± 7.7	43.6 ± 4.6
Moderate depression (score 20-28, n = 8)	38.4 ± 13.3	28.2 ± 8.3	62.3 ± 7.2	58.8 ± 4.3
Severe depression (score > 28, n = 0)	-	-	-	-
P value	0.010	< 0.001	< 0.001	< 0.001

¹One-way ANOVA;

²ANOVA linear term.

Table 5 Relationship between demographic and clinical characteristics of the 44 patients who completed the questionnaires and the results of the questionnaires used (in bold the significant associations)

	P
	SF-12 PCS	SF-12 MCS	GHQ-12	STAI Y-1	STAI Y-2	BDI-II
Gender (males vs females)	0.5891	0.6301	0.4802	0.3171	0.2141	0.3873
Age at interview	0.1134	0.0424 (r = 0.309)	0.3511	0.0384 (r = -0.314)	0.3094	0.5255
Disease duration	0.9624	0.7514	0.9121	0.6694	0.7524	0.8565
BMI	0.7664	0.1854	0.1251	0.2414	0.5144	0.7235
Marital status (single vs married)	0.1811	0.0931	0.2372	0.1101	0.5561	0.4433
Diploma (trend from elementary school to university degree)	0.1855	0.9165	0.6483	0.7055	0.3735	0.4053
Job (workers vs retired)	0.2401	0.0321 (-9.4 ± 4.23)	0.2402	0.0541	0.0571	0.2273
Alcohol habit (drinkers vs non-drinkers)	0.4071	0.7451	0.4802	0.6531	0.7241	0.9303
Smoking habit (smokers vs non-smokers)	0.3491	0.4651	0.2942	0.1241	0.1221	0.6013
Comorbidities (present vs absent)	0.6511	0.9231	1.0002	0.4351	0.2021	0.4023
Non-disease specific drugs (yes vs no)	0.0321 (-8.7 ± 3.9)	0.3221	0.0852	0.3691	0.1521	0.1403
Previous surgery not due to neuroendocrine tumors (yes vs no)	0.7751	0.2381	0.2412	0.4391	0.4371	0.3213
Surgery due to pancreatic neuroendocrine tumors (yes vs no)	0.0491 (8.1 ± 4.0)	0.7781	0.6692	0.9871	0.8801	0.9573
Disease status (disease free patients vs patients having lymph node involvement or liver metastases)	0.8751	0.4541	1.0002	0.3001	0.1691	0.1053
Specific treatment (yes vs no)	0.8161	0.4541	0.7222	0.9251	0.7331	0.9853
Pain in the last month (present vs absent)	0.1521	0.3711	0.0752	0.0461 (7.4 ± 3.6)	0.0491 (6.7 ± 3.3)	0.1903
Dyspepsia (present vs absent)	0.1151	0.0251 (-8.7 ± 3.8)	0.7282	0.1991	0.1951	0.01536
Diabetes (present vs absent)	0.9081	0.2631	0.4572	0.8831	0.5811	0.9383

¹One-way ANOVA (effect estimates; mean ± SE);

²Fisher exact test;

³Liner-by-linear association chi-square (frequencies);

⁴Pearson correlation (regression coefficient; r);

⁵One-way linear term ANOVA;

⁶Frequency of dyspepsia: according to BDI-II: absence of depression (score ≤ 13) 10/27 (37.0%); mild depression (score 14-19) 8/9 (88.9%); moderate depression (score 20-28) 6/8 (75.0%). In order to quantify the relationships, the various effect estimates - evaluated according to the statistical analysis applied - have been reported in parentheses.