key: cord-1041786-fejl8zw3
authors: Lauricella, E.; Cives, M.; Felici, V.; Bracigliano, A.; S. lamia,; Lippolis, R.; Amoruso, B.; Pelle, E.; Esposto, C.; Mandriani, B.; Di Lorenzo, G.; Clemente, O.; Porta, C. G.; Tafuto, S.
title: 1109P The psychological impact of COVID-19 pandemic on patients with NETs: Between resilience and vulnerability
date: 2021-09-30
journal: Annals of Oncology
DOI: 10.1016/j.annonc.2021.08.191
sha: e4d794e93c1620baf11883e487b096efb3137225
doc_id: 1041786
cord_uid: fejl8zw3

Background: The COVID-19 pandemic has dramatically changed lifestyles and quality of life (QoL) of the global population. Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic (GEP) or bronchopulmonary (BP) neuroendocrine tumors (NETs). Methods: We prospectively evaluated seven specific constructs (depression, anxiety, stress, QoL, NET-related QoL, patient-physician relationship, psychological distress) by using validated screening instruments including the Depression anxiety stress scale-21 (DASS-21), the EORTC QLQ-C30, the EORTC QLQ GI.NET21, the patient doctor relationship questionnaire 9 (PDRQ9) and the Impact of event scale-revised (IES-R). Mental symptoms and concerns of patients with any stage, well-differentiated GEP or BP-NET were surveyed twice, during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy. Results: We enrolled 197 patients (98 males) with a median age of 62 years (G1/G2: 96%;pancreas: 29%;small bowel: 25%;active treatment: 38%). At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, with no modifications in the frequency of stress. By ordinal logistic regression analysis, female patients showed more severe forms of stress at W1 (OR=0.45±0.14;p=0.01), while the educational status was associated with the levels of anxiety at both W1 (OR=1.33±0.22;p=0.07) and W2 (OR=1.45±0.26;p=0.03). An improvement of the physical (p=0.03) and emotional functioning domains (p=0.001) was observed over time. Both nausea/vomiting (p=0.0002), appetite (p=0.02), treatment-related symptoms (p=0.005), disease-related worries (p=0.0006) and sexual function (p=0.02) improved between W1 and W2, suggesting that NET patients were able to cope with the perturbations caused by the pandemic. No difference was seen between W1 and W2 in the mean score (>4/5) of the PDRQ9. By IES-R, post-traumatic stress disorder was observed in 53% of patients at W2. Conclusions: The implementation of psychological interventions within NET clinics might favor functional coping strategies, attenuating the psychological distress caused by the COVID-19 pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Background: Neuroendocrine neoplasms most commonly arise from the gastroenteropancreatic (GEP) system. The WHO classification of digestive system tumors describes four main types: Neuroendocrine tumor (NET) grades 1-3 and neuroendocrine carcinoma (NEC). NECs have an aggressive biology and are often diagnosed in an advanced stage associated with poor prognosis. First-line palliative chemotherapy is commonly carboplatin or cisplatin in combination with etoposide, while in secondline capecitabine-temozolomide, FOLFIRI or FOLFOX regimens are used. Few prospective studies have been done and data on efficacy is scarce. We conducted a retrospective study of patients with GEP-NEC treated with FOLFIRINOX, evaluating response to treatment and survival.

Methods: Patients diagnosed with GEP-NEC at three different centers and treated with FOLFIRINOX were identified and included in the study. Baseline demographics were collected at start of FOLFIRINOX. The Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria were used to assess the treatment response at computed tomography (CT).

Results: Thirty-seven patients between 2014 and 2020 were identified and included in the study. Median age was 53 years and female/male ratio was 1:1. Most of the patients were in WHO performance status 0 or 1 (86%). The most common primary tumor sites were colon (30%), pancreas (27%), oesophagus (10%)and rectum (10% Background: The COVID-19 pandemic has dramatically changed lifestyles and quality of life (QoL) of the global population. Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic (GEP) or bronchopulmonary (BP) neuroendocrine tumors (NETs).

We prospectively evaluated seven specific constructs (depression, anxiety, stress, QoL, NET-related QoL, patient-physician relationship, psychological distress) by using validated screening instruments including the Depression anxiety stress scale-21 (DASS-21), the EORTC QLQ-C30, the EORTC QLQ GI.NET21, the patient doctor relationship questionnaire 9 (PDRQ9) and the Impact of event scale-revised (IES-R). Mental symptoms and concerns of patients with any stage, well-differentiated GEP or BP-NET were surveyed twice, during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy.

We enrolled 197 patients (98 males) with a median age of 62 years (G1/G2: 96%; pancreas: 29%; small bowel: 25%; active treatment: 38%). At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, with no modifications in the frequency of stress. By ordinal logistic regression analysis, female patients showed more severe forms of stress at W1 (OR¼0.45AE0.14; p¼0.01), while the educational status was associated with the levels of anxiety at both W1 (OR¼1.33AE0.22; p¼0.07) and W2 (OR¼1.45AE0.26; p¼0.03). An improvement of the physical (p¼0.03) and emotional functioning domains (p¼0.001) was observed over time. Both nausea/ vomiting (p¼0.0002), appetite (p¼0.02), treatment-related symptoms (p¼0.005), disease-related worries (p¼0.0006) and sexual function (p¼0.02) improved between W1 and W2, suggesting that NET patients were able to cope with the perturbations caused by the pandemic. No difference was seen between W1 and W2 in the mean score (>4/5) of the PDRQ9. By IES-R, post-traumatic stress disorder was observed in 53% of patients at W2.

The implementation of psychological interventions within NET clinics might favor functional coping strategies, attenuating the psychological distress caused by the COVID-19 pandemic.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding. 

Background: COVID-19 pandemic has added a degree of complexity in the management of patients with NET. We have little information about the real impact of COVID-19 in current practice. The aim of this study is to capture if and how COVID-19 is changing the way in which healthcare professionals treat NET patients. Methods: NET CONNECT taskforce designed an online anonymous survey addressing different aspects of NET. Survey was sent to nurses and physicians working in ENETS Centers of Excellence

Tumor boards kept their usual schedule (60%), but were held virtually in 79%. Among main patient worries perceived by clinicians were the risk of COVID-19-related complications (64%), difficulties in the management of their disease (74%), or oncological medication (87%)