Pearman Timothy P, Beaumont Jennifer L, Cella David, Neary Maureen P, Yao James
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Support Care Cancer. 2016 Sep;24(9):3695-703. doi: 10.1007/s00520-016-3189-z. Epub 2016 Mar 31.
Neuroendocrine tumors (NETs) are malignant solid tumors arising in hormone-secreting tissue. They have historically been very difficult to treat, and advanced NETs are considered incurable. Surgery is the only potentially curative treatment option, though research is ongoing, investigating the efficacy of targeted therapies combined with more traditional chemotherapies. Frequent bowel movements and episodes of flushing are the most common symptoms.
The present study reports data from an anonymous patient survey of 663 eligible NET patients, identified with the assistance of patient advocacy groups. This study investigated the impact of treatment (surgery alone; surgery plus somatostatin analogue; other treatments) on quality of life (QOL). Finally, we investigate whether recurrent disease results in poorer QOL compared to disease treated curatively with surgery and remaining in remission.
Results suggest that increased frequency of bowel movements and presence of any flushing symptoms are correlated with decreased quality of life. Treatment groups differed on most Patient Reported Outcomes Measurement Information System (PROMIS) global health and PROMIS-29 scores, including physical function, fatigue, pain, social function, and general physical and mental health, with the surgery group reporting significantly better scores than the other groups (effect size of differences ranged from 0.28 to 0.54). This may be possibly due to effective symptom control reached for these patients through surgery alone. After adjustment for carcinoid syndrome, the association with the treatment group disappeared for all domains except physical functioning. In terms of disease status, patients with recurrent disease reported poorer physical, social, and mental functions. Depression scores were similar between groups; however, patients with recurrent disease reported significantly higher anxiety compared to those with no current NET. Physical functioning was even more markedly different between groups, with recurrent NET patients reporting significantly impaired overall physical function, impaired sleep, and significant fatigue compared to those with no current NET. To our knowledge, this is the first study to comprehensively examine the effect of treatment group, disease status, and symptom burden on the quality of life in NET patients in a large sample. Limitations and future research directions are discussed.
神经内分泌肿瘤（NETs）是起源于激素分泌组织的恶性实体瘤。从历史上看，它们一直很难治疗，晚期NETs被认为无法治愈。手术是唯一可能治愈的治疗选择，不过研究仍在进行，以调查靶向治疗与更传统化疗联合使用的疗效。频繁的排便和潮红发作是最常见的症状。
本研究报告了一项对663名符合条件的NET患者进行的匿名患者调查数据，这些患者是在患者权益倡导组织的协助下确定的。本研究调查了治疗（单纯手术；手术加生长抑素类似物；其他治疗）对生活质量（QOL）的影响。最后，我们调查与通过手术治愈并保持缓解的疾病相比，复发性疾病是否会导致较差的生活质量。
结果表明，排便频率增加和任何潮红症状的出现与生活质量下降相关。在大多数患者报告结局测量信息系统（PROMIS）全球健康和PROMIS - 29评分方面，治疗组存在差异，包括身体功能、疲劳、疼痛、社会功能以及总体身心健康，手术组报告的评分明显优于其他组（差异效应大小范围为0.28至0.54）。这可能是因为仅通过手术就为这些患者实现了有效的症状控制。在调整类癌综合征后，除身体功能外，所有领域与治疗组的关联均消失。就疾病状态而言，复发性疾病患者报告的身体、社会和心理功能较差。各组之间的抑郁评分相似；然而，与目前没有NET的患者相比，复发性疾病患者报告的焦虑明显更高。各组之间的身体功能差异更为明显，与目前没有NET的患者相比，复发性NET患者报告总体身体功能明显受损、睡眠受损和明显疲劳。据我们所知，这是第一项在大样本中全面研究治疗组、疾病状态和症状负担对NET患者生活质量影响的研究。讨论了局限性和未来的研究方向。
