title: Quality of life in 265 patients with gastroenteropancreatic or bronchial neuroendocrine tumors treated with [177Lu-DOTA0,Tyr3]octreotate.
abstract: Quality of life (QOL) is an important outcome in cancer therapy. In this study, we investigated the QOL and symptoms after [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-octreotate) therapy in patients with inoperable or metastasized gastroenteropancreatic or bronchial neuroendocrine tumors (NETs).
  
  
  METHODS
  Two hundred sixty-five Dutch patients completed the QOL questionnaire of the European Organization for the Research and Treatment of Cancer after being treated for NETs. ANOVA was used for statistical analyses, with a P value of 0.05 or less being considered significant. Differences of at least 10 points in global health status (GHS)/QOL scores, symptom scores, and Karnofsky performance scores (KPS) before and after therapy were regarded as indicating an improvement.
  
  
  RESULTS
  Regardless of the treatment outcome, GHS/QOL, insomnia, appetite loss, and diarrhea improved significantly in the total group. These improvements were also seen in patients with bone metastases or a decrease of 50% or more in chromogranin A. Improvement in the scores by at least 10 points was also analyzed in a subgroup of patients with decreased GHS/QOL or symptoms at the start of therapy: in 36% of these patients, GHS/QOL improved after therapy; in 49%, fatigue; in 70%, nausea plus vomiting; in 53%, pain; in 44%, dyspnea; in 59%, insomnia; in 63%, appetite loss; in 60%, constipation; and in 67%, diarrhea. Additionally, we did not see a statistically significant deterioration in patients who had GHS/QOL 100, KPS 100, or no symptoms at the start. In patients with initial stable disease or remission after treatment, GHS/QOL and KPS decreased significantly when regrowth of the tumors occurred.
  
  
  CONCLUSIONS
  GHS/QOL, KPS, and symptoms improved significantly after (177)Lu-octreotate therapy, and there was no significant decrease in QOL in patients who had no symptoms before therapy. In patients who had suboptimal scores for GHS/QOL or symptoms before therapy, a clinically significant improvement was demonstrated. Our results indicate that (177)Lu-octreotate therapy not only reduces tumors and prolongs overall survival but also improves the patients' self-assessed QOL.
authors.affiliation: Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. s.khan@erasmusmc.nl
authors.forename: Saima
authors.initials: S
authors.lastname: Khan
authors.forename: Eric P
authors.initials: EP
authors.lastname: Krenning
authors.forename: Martijn
authors.initials: M
authors.lastname: van Essen
authors.forename: Boen L
authors.initials: BL
authors.lastname: Kam
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Teunissen
authors.forename: Dik J
authors.initials: DJ
authors.lastname: Kwekkeboom
mesh_terms: D000855:Anorexia / Q000523:psychology; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D004644:Emotions / Q000502:physiology; D005260:Female; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D009362:Neoplasm Metastasis / Q000532:radiotherapy; D018358:Neuroendocrine Tumors / Q000523:psychology* / Q000532:radiotherapy*; D015282:Octreotide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D010190:Pancreatic Neoplasms / Q000523:psychology* / Q000532:radiotherapy; D011788:Quality of Life / Q000523:psychology*; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D012919:Social Behavior; D013274:Stomach Neoplasms / Q000523:psychology* / Q000532:radiotherapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C447941:lutetium Lu 177 dotatate; D015282:Octreotide