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©The Author(s) 2018.
World J Gastroenterol. Feb 14, 2018; 24(6): 671-679
Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.671
Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.671
Table 1 Summary of studies investigating psychological symptoms in patients with neuroendocrine tumours
| Ref. | Primary disease site | Correlation with treatment | Treatment | Number of patients with carcinoid syndrome/total patients | Method of investigation | Key results |
| Major et al[17] 1972 | Metastatic carcinoid | No | Not reported | 22/22 | Not reported | 50% displaying depressive symptoms |
| Larsson et al[11] 2001 | Midgut carcinoid | Yes – prior to and following 12 mo of treatment with somatostatin analogues | Somatostatin analogues | 20/24 | Questionnaire – EORTC- QLQC301 | Anxiety scores significantly lower at 12 mo than baseline, depression scores significantly higher at 9 mo |
| Russo et al[29] 2003 | Metastatic mid-gut carcinoid | No. Experimental tryptophan depletion | 12 patients somatostatin analogues, 2 patients no treatment | 14/14 | Cambridge Neuropsychological tests automated battery (CANTAB): intra-/extra- dimensional shift task, matching to sample visual search, rapid visual information processing and spatial working memory. | Impaired sustained attention. Not mimicking patients with depression |
| Larsson et al[27] 2003 | Carcinoid tumour | Yes | Somatostatin analogues or interferon | 19/19 | Semi-structured interview | Fatigue, diarrhoea, worry about diagnosis and limited physical ability most commonly reported symptoms |
| Russo et al[19] 2004 | Mid-gut carcinoid tumour with carcinoid syndrome | No | 14 patients on somatostatin analogues, 2 patients on interferon 2 patients no active treatment. 2 patients on somatostatin analogues + interferon | 20/20 | Semi-structured psychiatric interview | Impulse dysregulation leading to diagnosis of personality change secondary to a medical disorder in 15 patients (75%) |
Table 2 Patient characteristics - advanced gastroenteropancreatic neuroendocrine tumours with and without carcinoid syndrome n (%)
| All patientsn = 50 | With carcinoid syndromen = 25 | Without carcinoid syndrome n = 25 | P value | |
| Age (median) | 65.5 | 67 | 62 | 0.19 |
| 95%CI | (61.5-68.5) | (61.3-70.9) | (58.0-68.9) | |
| Gender | F:21 (42) M:29 (58) | F:9 (36) M:16 (64) | F: 12 (48) M: 13 (52) | 0.39 |
| Median time since diagnosis (mo) | 39 | 45 | 36 | 0.66 |
| (95%CI) | (21.54-48.46) | (20.10-48.90) | (18.21-56) | |
| Prior Surgery | 24 (48) | 9 (36) | 15 (60) | 0.09 |
| Recurrent disease following previous curative intent treatment | 8 (16) | 3 (12) | 5 (20) | 0.44 |
| Primary disease site | ||||
| Stomach | 1 (2) | 0 (0) | 1 (4) | |
| Small bowel | 29 (58) | 18 (72) | 11 (44) | |
| Pancreas | 11 (22) | 1 (4) | 10 (40) | |
| Large bowel | 3 (6) | 1 (4) | 2 (8) | |
| Unknown GI tract | 6 (12) | 5 (20) | 1 (4) | |
| Median Ki-67 | ||||
| % (95%CI) | 3 (2-4.8) | 2 (2-5) | 3 (2-7.7) | 0.55 |
| ECOG PS n (%) | ||||
| 0 | 14 (27) | 7 (28) | 7 (28) | |
| 1 | 30 (60) | 16 (64) | 14 (56) | |
| 2 | 4 (8) | 1 (4) | 3 (12) | |
| 3 | 2 (4) | 1 (4) | 1 (4) | |
| Current treatment | ||||
| Nil | 5 (10) | 2 (8) | 4 (16) | |
| Best supportive care | 1 (2) | 0 (0) | 1 (4) | |
| Chemotherapy | 5 (10) | 0 (0) | 5 (20) | |
| Interferon + Somatostatin analogue | 2 (4) | 2 (8) | 0 (0) | |
| Peptide receptor radionuclide Therapy | 2 (4) | 1 (4) | 1 (4) | |
| Peptide receptor radionuclide therapy + Somatostatin analogues | 2 (4) | 1 (4) | 1 (4) | |
| Somatostatin analogues | 28 (56) | 8 (72) | 9 (36) | |
| Tryptophan hydroxylase inhibitor + Somatostatin analogues | 1 (2) | 1 (4) | 0 (0) | |
| mTOR inhibitor | 4 (8) | 0 (0) | 4 (16) | |
| Use of psychoactive medications | ||||
| Nil | 44 (88) | 22 (88) | 22 (88) | |
| Selective serotonin Reuptake inhibitors | 3 (6) | 1 (4) | 2 (8) | |
| Benzodiazepine | 1 (2) | 1 (4) | 0 (0) | |
| Selective serotonin reuptake inhibitors + benzodiazepine | 1 (2) | 0 (0) | 1 (4) | |
| Unknown | 1 (2) | 1 (4) | 0 (0) | |
Table 3 Comparison of responses in patients with and without carcinoid syndrome in the HRQoL QLQ-C30 questionnaire
| Without carcinoid syndrome | With Carcinoid syndrome | Difference between groups | P value | |||
| Mean score | (95%CI) | Mean score | (95%CI) | |||
| Global health status | 63 | 52.3-73.7 | 61.7 | 49.6-73.7 | 1.3 | 0.92 |
| Physical functioning | 79.9 | 73.0-86.8 | 77.9 | 67.9-87.9 | 2.0 | 0.79 |
| Role functioning | 74 | 61.3-86.7 | 70.7 | 56.3-85.0 | 3.3 | 0.77 |
| Emotional functioning | 73 | 63.0 – 83.0 | 74.7 | 63.7-85.6 | -1.7 | 0.73 |
| Cognitive functioning | 76.7 | 66.3-87.0 | 74.0 | 61.0-87.0 | 2.7 | 0.93 |
| Social functioning | 70 | 58.6- 81.4 | 79.3 | 67.2-91.5 | -9.3 | 0.15 |
| Fatigue | 34.7 | 23.6-45.8 | 37.8 | 23.9-51.7 | -3.1 | 0.84 |
| Nausea and vomiting | 11.3 | 4.0-18.7 | 8.00 | 1.4-14.6 | 3.3 | 0.31 |
| Pain | 25.3 | 11.8-38.8 | 26.7 | 13.5-39.8 | -1.3 | 0.81 |
| Dyspnoea | 12.5 | 1.7-23.3 | 24.0 | 10.5-37.5 | -11.5 | 0.15 |
| Insomnia | 36 | 22.9-39.1 | 22.7 | 10.9-34.3 | 13.3 | 0.12 |
| Appetite loss | 18.7 | 8.1-29.2 | 22.7 | 9.7-35.7 | -4 | 0.81 |
| Constipation | 9.3 | 1.9-16.8 | 9.30 | 1.9-16.8 | 0 | 1.00 |
| Diarrhoea | 24 | 9.4-38.6 | 32.0 | 17.4-46.6 | -8.0 | 0.27 |
| Financial difficulties | 13.3 | 3.6-23.1 | 8.00 | -18.2 | 5.3 | 0.30 |
Table 4 Comparison of responses in patients with and without carcinoid syndrome in the HRQoL QLQ-GI.NET21 questionnaire
| Without carcinoid syndrome | With Carcinoid syndrome | Difference between groups | P value | |||
| Mean score | (95%CI) | Mean score | (95%CI) | |||
| Endocrine symptoms | 16.7 | 8.4-24.9 | 28.4 | 18.1-38.8 | -11.8 | 0.04 |
| Gastrointestinal symptoms | 18.9 | 12.7-25.3 | 24.0 | 16.5-31.5 | -5.1 | 0.37 |
| Treatment-related symptoms | 17.5 | 8.6-26.4 | 10.1 | 4.1-16.2 | 7.4 | 0.20 |
| Social functioning | 60.0 | 50.0-70.0 | 68.4 | 58.7-78.1 | -8.4 | 0.19 |
| Disease-related worries | 56.9 | 43.0-70.8 | 38.7 | 26.2-51.2 | 18.2 | 0.05 |
| Body image | 15.3 | 4.3-26.2 | 13.3 | 2.1-24.6 | 1.9 | 0.57 |
| Weight gain | 18.7 | 7.4-30.0 | 13.3 | 2.1-24.6 | 5.3 | 0.30 |
| Muscle/bone pain | 41.3 | 28.6-54.1 | 46.7 | 31.3-62.1 | -5.3 | 0.62 |
| Information | 10.7 | 2.0-19.3 | 16.0 | 4.7-27.3 | -5.3 | 0.51 |
| Sexual functioning | 60.8 | 35.6-85.9 | 68.4 | 47.4-89.5 | -7.6 | 0.82 |
- Citation: Lewis AR, Wang X, Magdalani L, D’Arienzo P, Bashir C, Mansoor W, Hubner R, Valle JW, McNamara MG. Health-related quality of life, anxiety, depression and impulsivity in patients with advanced gastroenteropancreatic neuroendocrine tumours. World J Gastroenterol 2018; 24(6): 671-679
- URL: https://www.wjgnet.com/1007-9327/full/v24/i6/671.htm
- DOI: https://dx.doi.org/10.3748/wjg.v24.i6.671