Health-related quality of life, anxiety, depression and impulsivity in patients with advanced gastroenteropancreatic neuroendocrine tumours

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%)

¹European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life QLQ-C30 questionnaire.

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)

CI: Confidence interval; ECOG PS: Eastern Cooperative Oncology Group performance status.

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

HRQoL: Health-related quality of life.

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