Carcinoid syndrome-related symptoms in pancreatic neuroendocrine tumors (pNETs) and impact on health care utilization.

Abstract

450 Background: PNETs, rare neoplasms originating from secretory neuroendocrine cells, produce peptides and neuroamines causing hormonal syndromes, including carcinoid syndrome (CS). Somatostatin analogues (SSAs) are usual 1st-line treatment; everolimus and sunitinib are targeted therapies (TT) approved for progressive disease. Carcinoid or hormonal symptoms associated with CS may occur in pNET and are treated with SSAs. Information is limited on impact of these symptoms on health resource use in pNET. Methods: This retrospective cohort study merged 2 large HIPAA-compliant claims databases and identified pNET patients (ICD-9-CM 157.4) initiating treatment with TT or cytotoxic chemo (CC) from 2009-2012. Patients had no prior TT or CC for pNET for 1 year preindex and were continuously enrolled 1 year postindex. Descriptive statistics were reported for comorbidities and health care use, overall and by presence of symptoms defined to include: diarrhea, nausea/vomiting, flushing, cardiac palpitations, asthma, wheezing, fatigue, hypotension, or dizziness. Chi-square and t-tests were used for analyses of categorical and continuous variables, respectively. Results: This study included 338 newly treated pNET patients with 1 year followup; 237 1st-line CC and 101 TT (64 everolimus, 37 sunitinib). Mean age was 54.5; 46% female. Patients had mean of 5 (SD 2.0) chronic conditions and Charlson Index of 10.1 (SD 2.9). Utilization included 43.5% hospitalizations, 48.8% ED visits, and mean of 25.5 (SD 24.8) office visits. 212 (62.7%) patients had symptoms. Other conditions were infection (34.9%) and anemia (29.9%). PNET patients with symptoms had considerably higher rates of hospitalization, ED visits, and office visits than those without: 57.5% vs. 19.8%, 64.2% vs. 23.0%, mean 29.2 vs. 19.3, all P < 0.001. Conclusions: In this study, nearly 2/3 of treated pNET patients had carcinoid or hormonal symptoms; about 1/3 had infection and anemia. Symptoms may influence drug treatment patterns. PNET patients with symptoms were high utilizers of health resources; over half were treated as inpatients and more sought ED care. This increased use may result from a high burden of symptoms and comorbid conditions.