Impact of treatment on quality of life in neuroendocrine neoplasm survivors

Abstract

Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors, ranging from well-differentiated, slow-growing neuroendocrine tumor (NET) with long-term survival, to aggressive high-grade neuroendocrine carcinoma (NEC). Advances in treatment and earlier diagnosis have led to improved survival outcomes; however, data regarding patients' quality of life (QoL) during therapy and in the post-treatment phase remain limited. This narrative review aims to analyze available data on QoL in NEN patients undergoing medical therapies, including nutritional considerations, to improve and personalize therapeutic strategies. A literature search was performed using online databases, including MEDLINE (via PubMed) and Scopus, employing multiple keyword combinations up to October 2024. Somatostatin analogs (SSAs) and radioligand therapy (RLT) have demonstrated good tolerability profiles and efficacy on QoL, especially in patients with carcinoid syndrome, impacting on both physical and emotional domains. In contrast, multikinase inhibitors have been associated with declines in general health status, and sexual and physical function. Data on chemotherapy are conflicting, with some evidence suggesting a favorable QoL profile due to tumor control. Interestingly, approximately 30% of NEN survivors report persistence of symptoms related to depression. Both treatment-related side effects and disease-related symptoms may impact QoL, affecting nutritional status, which should be carefully considered. Despite standardized QoL, assessments are lacking in nutritional studies, and adherence to a Mediterranean diet seems to positively influence symptom burden in NEN patients. In conclusion, evidence supports that SSA and RLT contribute to improved QoL, likely due to symptom control. Further research is needed to better characterize the QoL impact of other therapies using standardized assessment tools, in order to optimize therapeutic management.

Keywords: chemotherapy; neuroendocrine neoplasms (NEN); quality of life (QoL); radioligand therapy (RLT); somatostatin analog (SSA); survivors; targeted therapies; telotristat.