title: Health-related quality of life in well-differentiated metastatic gastroenteropancreatic neuroendocrine tumors.
abstract: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare neoplasms capable of producing hormones. The development of new treatments has improved progression-free survival, albeit with increased toxicity. Health-related quality of life (HRQoL) has become an important endpoint in clinical research to evaluate patients' well-being in such a contradictory scenario. In this review, we examine key reported outcomes across clinical studies exploring HRQoL in patients with GEP-NETs. We have conducted a review of the literature using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Selection criteria for articles were (1) publication in English between 1995 and 2014, (2) patients with GEP-NET, and (3) analysis of HRQoL, including mental health and psychological symptoms. Forty-nine studies met the inclusion criteria (31 clinical trials, 14 observational studies, and 4 developments of NET-specific HRQoL instruments). The scope and nature of the literature was diverse with 27 instruments used to measure aspects of HRQoL. EORTC QLQ-C30 was the most frequently used, in 38 of the 49 studies. Standardized measures revealed that in spite of generally good HRQoL, GEP-NET patients have specific psychological and physical complaints. The clinical benefit of somatostatin analogs and sunitinib has been clearly supported by HRQoL assessment. Improvement in HRQoL scores or symptom relief over time was also reported in 14 trials of peptide receptor radionuclide therapy, however the absence of randomized studies obviate definitive conclusions. We have also identified several unanswered questions that should be addressed in further research concerning chemotherapy, everolimus, surgery, local ablative therapies, and chemoembolization. Future research should incorporate GEP-NET-specific HRQoL instruments into phase III trials. This review may help both clinicians and researchers to select the most appropriate tools to assess changes in HRQoL in this population.
authors.affiliation: Department of Medical Oncology, Central Asturias University Hospital, C/ Avenida de Roma sn, Oviedo, 33011, Asturias, Spain. palucaji@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Department of Hematology and Medical Oncology, Morales Meseguer University Hospital, Murcia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Department of General Surgery, La Princesa University Hospital, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Martín-Pérez
authors.affiliation: Department of Medical Oncology, Burgos University Hospital, Burgos, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Crespo
authors.affiliation: Department of Medical Oncology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Serrano
authors.affiliation: Department of Medical Oncology, Canarias University Hospital, Tenerife, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Llanos
authors.affiliation: Department of Endocrinology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Villabona
authors.affiliation: Department of Medical Oncology, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (IBIS) [Universidad de Sevilla, CSIC, HUVR], Center affiliated with the Red Temática de Investigación Cooperativa en Cancer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Sevilla, Spain.
authors.forename: R
authors.initials: R
authors.lastname: García-Carbonero
authors.affiliation: Department of Endocrinology, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Aller
authors.affiliation: Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Center affiliated with the Red Temática de Investigación Cooperativa en Cancer (RTICC), Instituto Carlos III, Spanish Ministry of Science and Innovation, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Capdevila
authors.affiliation: Department of Medical Oncology, Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Grande
mesh_terms: D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy*; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000523:psychology* / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy*
keywords: Chemotherapy; Gastroenteropancreatic neuroendocrine tumors (GEP-NETs); Health-related quality of life (HRQoL); Locoregional therapy; Peptide receptor radionuclide therapy (PRRT); Quality of life (QoL); Questionnaires; Somatostatin analogs (SSA); Surgery; Targeted therapy