Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.671
Peer-review started: October 27, 2017
First decision: November 21, 2017
Revised: December 11, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: February 14, 2018
Processing time: 103 Days and 10.4 Hours
To compare health-related quality of life (HRQoL), anxiety, depression, and impulsivity scores in patients with and without carcinoid syndrome (CS), and correlated them with serum 5-hydroxyindoleacetic acid (5-HIAA) levels.
Patients with advanced gastroenteropancreatic neuroendocrine tumours (GEPNET), with and without CS completed HRQoL QLQ-C30 and QLQ-GI.NET21, Hospital Anxiety and Depression Scale (HADS) and Barratt Impulsivity Scale (BIS) questionnaires. Two-sample Wilcoxon test was applied to assess differences in serum 5-HIAA levels, two-sample Mann-Whitney U test for HRQoL and BIS, and proportion test for HADS, between those with and without CS.
Fifty patients were included; 25 each with and without CS. Median 5-HIAA in patients with and without CS was 367nmol/L and 86nmol/L, respectively (P = 0.003). Scores related to endocrine symptoms were significantly higher amongst patients with CS (P = 0.04) and scores for disease-related worries approached significance in the group without CS, but no other statistically-significant differences were reported between patients with and without CS in responses on QLQ-C30 or QLQ-GI.NET21. Fifteen patients (26%) scored ≥ 8/21 on anxiety scale, and 6 (12%) scored ≥ 8/21 on depression scale. There was no difference in median 5-HIAA between those scoring < or ≥ 8/21 on anxiety scale (P = 0.53). There were no statistically significant differences between groups in first or second-order factors (BIS) or total sum (P = 0.23).
Excepting endocrine symptoms, 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.
Core tip: Patients with functioning gastroenteropancreatic neuroendocrine tumours (GEPNETs) may have higher levels of psychological distress than other patients with cancer due to the symptoms of hormone hypersecretion. This study compares 25 patients with advanced GEPNET and carcinoid syndrome (CS) with 25 patients with advanced, but non-functioning GEPNET. Symptoms of anxiety, depression, impulsivity and health-related quality of life were assessed prospectively using symptom scales. Endocrine symptoms were significantly higher in patients with CS. Disease-related worries were more common in those with non-functioning tumours. This is a large study in this rare patient group and further prospective studies are required.