title: United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment.
abstract: OBJECTIVE
  To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States.
  
  
  METHODS
  United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g., surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites).
  
  
  RESULTS
  Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared to pNET. Chemotherapy utilization was also greater among GI/Lung types. Multivariate analysis results demonstrated that patients in first progression period were over 3 times more likely to receive chemotherapy when compared to baseline (odds ratio: 3.31; 95%CI: 1.46-7.48, P = 0.0041). Further, progression was associated with a greater likelihood of having a study physician visit [relative risk (RR): 1.54; 95%CI: 1.10-2.17, P = 0.0117], and an increased frequency of other physician visits (RR: 1.84; 95%CI: 1.10-3.10, P = 0.0211).
  
  
  CONCLUSIONS
  Resource utilization in advanced NET in the United States is significant overall and data suggests progression has an impact on resource utilization regardless of NET tumor site.
authors.affiliation: H Lee Moffitt Cancer Center and Research Institute, Gastrointestinal Tumor Department, Tampa, FL 33612, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Strosberg
authors.forename: Roman
authors.initials: R
authors.lastname: Casciano
authors.forename: Lee
authors.initials: L
authors.lastname: Stern
authors.forename: Rohan
authors.initials: R
authors.lastname: Parikh
authors.forename: Maruit
authors.initials: M
authors.lastname: Chulikavit
authors.forename: Jacob
authors.initials: J
authors.lastname: Willet
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.forename: Xufang
authors.initials: X
authors.lastname: Wang
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Grzegorzewski
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology; D014408:Biomarkers, Tumor; D018450:Disease Progression; D006760:Hospitalization; D006801:Humans; D008495:Medical Oncology / Q000592:standards* / Q000639:trends; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000628:therapy*; D016012:Poisson Distribution; D010818:Practice Patterns, Physicians'; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
keywords: Clinical practice patterns; Gastrointestinal cancers; Health economics; Neuroendocrine tumors; Resource utilization