Introduction: Neuroendocrine tumours (NETs) have diverse natural history and clinical syndromes. As a result of the disease or related to management, patients may have altered gut or pancreatic function that can cause nutritional deficiencies. There is a lack of consistent evidence-based dietetic guidance for patients with NETs.
Aim: This study evaluated whether nutritional status and nutritional deficiencies had been assessed in patients with NETs in an existing service in South Wales.
Method: A retrospective study included 141 NET patients seen in Gastroenterology (n=74) and Endocrinology (n=67) clinics. Key parameters collected were: BMI, weight, vitamin B12, Ferritin, Folate, Albumin, vitamins A/D/E and presence of steatorrhoea. Evidence of treatment with vitamin or iron replacement and use of bile acid sequestrants or Creon was also recorded.
Results: Weight was recorded in under half of patients (70/141) and BMI in just 14% (n=20). This rose to 100 and 73% respectively in patients seen by a gastro-specialist dietitian; only 22 patients (16%) had this specialist input. Fifty four patients reported weight loss, 70% of these (n=38) had a quantified weight loss, 46% had percentage weight loss calculated. One hundred and six patients (75%) had been investigated for a form of vitamin or iron deficiency. The likelihood of investigation was significantly higher in Gastroenterology clinic patients than Endocrine clinics (95% vs 54%, P<0.01). 57% of those investigated were found to have a deficiency, which was consistent across specialities: 59% (41/70) of those from Gastroenterology clinics and 53% (19/36) from Endocrine clinics. 41/60 patients (68%) with a recorded deficiency did not have sufficient replacement. 7/27 patients with iron deficiency were given supplementation. Thirty eight patients had vitamin D levels tested (27%), 29 were insufficient (76%). Twenty seven patients reported steatorrheoa, 26 of whom were prescribed somatostatin analogues. 96% of these patients were also prescribed Creon.
Conclusion: Although higher rates of nutritional assessment were found in patients who had been assessed by Gastroenterology and with gastro-specialist dietetic involvement, assessment and management of nutritional status in patients with NETs remains an unmet need. Further evidence is required to evaluate nutritional assessment in NETs.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society