Kreppel Barbara, Jochims Hannah M, Marinova Milka, Küppers Jim, Schmidt-Wolf Ingo G H, Feldmann Georg, Gonzalez-Carmona Maria Angeles, Essler Markus
Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany.
Department of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
Nuklearmedizin. 2025 Aug;64(4):242-249. doi: 10.1055/a-2641-7759. Epub 2025 Jun 30.
Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies characterized by variable clinical presentations and significant psychological burdens. Peptide receptor radionuclide therapy (PRRT) with [Lu]Lu-DOTATATE is a cornerstone in managing somatostatin receptor-positive NETs. This study investigates the role of psycho-oncological screening using the Hornheider Screening Instrument (HSI) in identifying psychosocial distress and its impact on overall survival (OS) and progression-free survival (PFS) in NET patients undergoing PRRT.A cohort of 100 NET patients with progressive disease scheduled for PRRT was retrospectively analyzed. All patients underwent psycho-oncological screening before PRRT using HSI. Patients were stratified into four groups, based on their screening results and acceptance or refusal of psycho-oncological support. Clinical outcomes, including PFS and OS, were assessed, and subgroup analyses were performed to identify potential predictors of survival.Among 38 patients identified as needing psycho-oncological support, 9 accepted and 29 declined treatment. Patients who accepted psycho-oncological care demonstrated a 100% survival rate, comparable to patients with no significant distress. In contrast, patients who declined care exhibited a significantly shorter OS (median 83.7 months) and a higher death rate (38%). No differences were observed in PFS across groups. Subgroup analysis revealed similar tumor grading, pretreatment, and therapeutic regimens, suggesting that psychosocial factors influence OS independent of disease progression. Notably, women were more likely to accept psycho-oncological support than men.Psycho-oncological distress significantly impacts OS in NET patients undergoing PRRT. Acceptance of psycho-oncological care was associated with improved survival, highlighting the importance of integrating psychological support into routine NET management. These findings underscore the need for tailored psycho-oncological interventions, especially for patients at high risk who decline care. Further studies are warranted to elucidate the mechanisms linking psychosocial factors with clinical outcomes.
神经内分泌肿瘤（NETs）是一组异质性恶性肿瘤，其临床表现各异，给患者带来巨大心理负担。使用[镥]镥-奥曲肽的肽受体放射性核素治疗（PRRT）是治疗生长抑素受体阳性NETs的基石。本研究调查了使用霍恩海德筛查工具（HSI）进行心理肿瘤学筛查在识别社会心理困扰及其对接受PRRT的NET患者总生存期（OS）和无进展生存期（PFS）的影响方面的作用。
对100例计划接受PRRT的进展期疾病NET患者进行了回顾性分析。所有患者在PRRT前使用HSI进行心理肿瘤学筛查。根据筛查结果以及对心理肿瘤学支持的接受或拒绝情况，将患者分为四组。评估了包括PFS和OS在内的临床结局，并进行亚组分析以确定生存的潜在预测因素。
在38例被确定需要心理肿瘤学支持的患者中，9例接受了治疗，29例拒绝了治疗。接受心理肿瘤学护理的患者生存率为100%，与无明显困扰的患者相当。相比之下，拒绝护理的患者OS明显较短（中位生存期83.7个月），死亡率较高（38%）。各组之间在PFS方面未观察到差异。亚组分析显示肿瘤分级、预处理和治疗方案相似，这表明社会心理因素独立于疾病进展影响OS。值得注意的是，女性比男性更有可能接受心理肿瘤学支持。
心理肿瘤学困扰对接受PRRT的NET患者的OS有显著影响。接受心理肿瘤学护理与生存率提高相关，突出了将心理支持纳入NET常规管理的重要性。这些发现强调了需要进行针对性的心理肿瘤学干预，特别是对于拒绝护理的高危患者。有必要进一步研究以阐明社会心理因素与临床结局之间的联系机制。
