United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment

Table 1 Any time resource utilization by neuroendocrine tumor type¹n (%)

	All NET (n = 110)	GI/lung NET (n = 70)	pNET (n = 40)
Treatments
Surgery	50 (45.45)	30 (42.86)	20 (50.00)
Chemotherapy2	42 (38.18)	30 (42.86)	12 (30.00)
PRRT	6 (5.45)	6 (8.57)	0 (0.00)
Somatostatin	86 (78.18)	54 (77.14)	32 (80.00)
Targeted therapy3	7 (6.36)	5 (7.14)	2 (5.00)
Resources
Hospitalizations	62 (56.36)	40 (57.14)	22 (55.00)
Ultrasounds	42 (38.18)	22 (31.43)	20 (50.00)
CT scans	79 (71.82)	53 (75.71)	26 (65.00)
Helical scans	42 (38.18)	27 (38.57)	15 (37.50)
Other imaging tests4	64 (58.18)	41 (58.57)	23 (57.50)
Bio marker5	73 (66.36)	47 (67.14)	26 (65.00)
Other lab tests6	70 (63.64)	41 (58.57)	29 (72.50)
Physician visit	109 (99.09)	40 (100.00)	69 (98.57)

¹A patient was counted (once) if that individual utilized a resource at any stage of their disease;

²Chemotherapy includes 5-fluorouracil, actinomycin-D, capecitabine, carboplatin, cisplatin, cyclophosphamide, dacarbazine, doxorubicin, etoposide, gemcitabine, irinotecan, mitotane, oxaliplatin, streptozocin, temozolomide and vincristine;

³Targeted therapy includes everolimus, sunitinib, imatinib, and bevacizumab; the data collection form captured these therapies under the heading “other treatments”;

⁴Other imaging includes positron emission tomography, stereotactic radiosurgery, metaiobenzylguanidine, magnetic resonance imaging, and chest X-ray;

⁵Biomarkers include neurotensin, chromogranin A, pancreatic polypeptide, neurotensin, plasma serotonin, vasoactive intestinal polypeptide, ghrelin, human chorionic gonadotropin, Ki-67, 5-hydroxyndoleacetic acid, plasma substance P, total and free T4;

⁶Other lab tests include serum glucose, complete blood count, blood urea nitrogen, serum creatinine, and lipid profile were captured. PRRT: Peptide-receptor radionuclide therapy; NET: Neuroendocrine tumor; pNET: Pancreatic NET; GI: Gastrointestinal tract; CT: Computed tomography.

Table 2 Resource utilization by progression state n (%)

	Baseline			Any progression
	All NET	GI/Lung	pNET	All NET	GI/Lung	pNET
Treatments
Chemotherapy1	17 (16.4)	17 (25.0)	0 (0.0)	46 (26.9)	30 (27.0)	16 (26.7)
Targeted therapies2	3 (2.9)	2 (2.9)	1 (2.8)	6 (3.5)	5 (4.5)	1 (1.7)
PRRT	3 (2.9)	3 (4.4)	0 (0.0)	39 (6.1)	5 (4.5)	0 (0.0)
Somatostatin analogs	66 (63.5)	43 (63.2)	23 (63.9)	83 (48.5)	52 (46.9)	31 (51.7)
Surgery	29 (27.9)	17 (25.0)	12 (33.3)	42 (24.6)	26 (23.4)	16 (26.7)
Resources
Hospitalizations	34 (32.7)	23 (33.8)	11 (30.6)	72 (42.1)	44 (39.6)	28 (46.7)
Ultrasound	38 (36.5)	20 (29.4)	18 (50.0)	34 (19.9)	22 (19.8)	12 (20.0)
CT scans (conventional)	62 (59.6)	43 (63.2)	19 (52.8)	109 (63.7)	72 (64.9)	37 (61.8)
CT scans (helical or spiral)	23 (22.1)	15 (22.1)	8 (22.2)	51 (29.8)	33 (29.7)	18 (30.0)
Other imaging3	51 (49.0)	31 (45.6)	20 (55.6)	52 (30.5)	33 (29.7)	19 (31.7)
Biomarkers4	66 (63.4)	44 (64.7)	22 (61.1)	84 (49.1)	55 (49.6)	29 (48.3)
Lab tests5	61 (58.7)	36 (52.9)	25 (69.4)	84 (49.1)	50 (45.1)	34 (56.7)
Study physician visit	102 (98.08)	66 (97.06)	36 (100.00)	165 (96.49)	107 (96.40)	58 (96.67)
Other physician visit	77 (74.04)	50 (73.53)	27 (75.00)	143 (83.62)	92 (82.88)	51 (85.00)

¹Chemotherapy includes 5-fluorouracil, actinomycin-D, capecitabine, carboplatin, cisplatin, cyclophosphamide, dacarbazine, doxorubicin, etoposide, gemcitabine, irinotecan, mitotane, oxaliplatin, streptozocin, temozolomide and vincristine;

²Targeted Therapy includes everolimus, sunitinib, imatinib, and bevacizumab; the data collection form captured these therapies under the heading “other treatments”;

³Other imaging includes positron emission tomography, stereotactic radiosurgery, metaiobenzylguanidine, magnetic resonance imaging, and chest X-ray;

⁴Biomarkers include neurotensin, chromogranin A, pancreatic polypeptide, neurotensin, plasma serotonin, vasoactive intestinal polypeptide, ghrelin, human chorionic gonadotropin, Ki-67, 5-hydroxyndoleacetic acid, plasma substance P, total and free T4;

⁵Other lab tests include serum glucose, complete blood count, blood urea nitrogen, serum creatinine, and lipid profile were captured. PRRT: Peptide-receptor radionuclide therapy; NET: Neuroendocrine tumor; pNET: Pancreatic NET; GI: Gastrointestinal tract; CT: Computed tomography.

Table 3 Multivariate analysis for resource use prevalence among patients at first progression vs baseline¹

Resource1	Beta	Odds	95%CI		P
	estimate	ratio	Lower bound	Upper bound	value
Chemotherapy	1.1962	3.3074	1.4625	7.4795	0.00412
Somatostatin analogs	0.5298	1.6986	0.8038	3.5892	0.1652
Surgery	0.4551	1.5763	0.7632	3.2556	0.2188
Hospitalization	0.3227	1.3808	0.6920	2.7550	0.3599
Other physician visit	0.7336	2.0826	0.9185	4.7221	0.0790

¹Generalized estimating equations model (assuming binomial distribution and unstructured covariance structure) while controlling for primary neuroendocrine tumor location, age, Eastern Cooperative Oncology Group status, tumor histology, physician specialty and follow-up time;

²Value denotes statistical significance.

Table 4 Multivariate analysis for patient hospitalization and physician visit frequency at first progression vs baseline

Resource	Beta	Rate	95%CI		P
	estimate	ratio	Lower bound	Upper bound	value
Study physician visit1	0.4346	1.5444	1.1014	2.1656	0.0117
Hospitalizations2	-0.0617	0.9402	0.2648	3.3379	0.9240
Study physician visits2	0.1321	1.1412	0.8330	1.5635	0.4108
Other physician visits2	0.6116	1.8433	1.0961	3.0999	0.0211

¹Generalized estimating equations model (assuming binomial distribution and unstructured covariance structure) while controlling for primary neuroendocrine tumor location, age, Eastern Cooperative Oncology Group status, tumor histology, physician specialty and follow-up time;

²Value denotes statistical significance.