Background: In patients with advanced GEPNETs, psychological symptoms may result due to potential disturbances in biogenic amines, particularly serotonin. This study compared HRQoL, anxiety, depression, and impulsivity in patients with and without carcinoid syndrome (CS) and correlated with serum 5-HIAA.
Methods: Consecutive patients with advanced GEPNETs (with liver metastases) receiving treatment, with and without CS completed (single time-point) HRQoL QLQ-C30 and QLQ-GI.NET21, Hospital Anxiety and Depression Scale (HADS) [score of ≥8/21 cut-off for anxiety/depression] and Barrett Impulsivity Scale (BIS). First-order factors analysed included: attention, cognitive instability, motor, perseverance, self-control, cognitive complexity; second-order factors: attentional, motor and non-planning. Two-sample Wilcoxon (Mann Whitney test) was applied to assess differences in serum 5-HIAA, two-sample Mann-Whitney U test for HRQoL and BIS, and proportion test for HADS, between those with and without CS.
Results: Fifty patients were included (April-August 2016); 25 each with and without CS. Median age was 66 years, 29 (58%) male, 44 (88%) ECOG performance status 01, primary site; small bowel: 29 (58%), pancreas: 11 (22%), gastric and large bowel: 10 (20%), recurrent disease in 8 (16%). Five patients (10%) were taking prescribed psychoactive medications. Median time since diagnosis was 39.5 months (95%-confidence interval 21.548.5). Current median serum 5-HIAA in patients with and without CS was 367 nmol/l and 86 nmol/l respectively (P=0.003). No statistically-significant differences were reported between patients with and without CS in responses on QLQ-C30 or QLQ-GI.NET21; responses relating to physical functioning and endocrine symptoms approached significance (P=0.09 for both). Fifteen patients (26%) scored ≥8/21 on anxiety scale; 8 had CS, and 6 (12%) scored ≥8/21 on depression scale; 3 with CS. There was no difference in median 5-HIAA between those scoring < or ≥8/21 on anxiety scale (P=0.53). Proportion test was not statistically significant between groups for anxiety (P=0.76) or depression (P=1.0). There were no statistically significant differences between groups in first or second-order factors (BIS) or total sum (P=0.23).
Conclusion: There were no significant differences in HRQoL, anxiety, depression or impulsivity between patients with advanced GEPNET with or without CS. Over one quarter of patients had high anxiety scores (unrelated to peripheral serotonin metabolism), indicating importance of psycho-oncological intervention.
05 Dec 2016
UK and Ireland Neuroendocrine Tumour Society