Abstract
Introduction
The survival benefit of chemotherapy for patients with metastatic gastroenteropancreatic
neuroendocrine carcinomas (GEP-NECs) is well established. However, reasons for underutilization
of chemotherapy are unknown.
Methods
The National Cancer Database (NCDB) was queried for metastatic GEP-NECs from 2009
to 2016. The cohort was stratified by patients who had received chemotherapy and who
did not receive chemotherapy. Demographic, socioeconomic, clinical, and treatment
characteristics were captured. Multivariable logistic regression examined factors
associated with chemotherapy utilization.
Results
Of the 2367 stage IV GEP-NECs patients identified, 1647 (69.6%) received chemotherapy.
Patients with primary site at colon and small bowel, age ≥75, no insurance, and ≥2
comorbidities were less likely to receive chemotherapy than patients with other primary
sites, age <75, private insurance, and no comorbidities (P < 0.005). The small bowel and colon were the primary sites with the greatest percentage
of patients who received surgery (46.4% and 41.8%, respectively). In these subgroup
of patients, surgical intervention was also associated with lower probability of receiving
chemotherapy (odds ratio = 0.60, P < 0.005).
Conclusions
About 30% of patients with metastatic GEP-NECs did not receive chemotherapy. Primary
site location and receipt of surgery were significantly associated with receipt of
chemotherapy, with NECs in small bowel and colon being more likely to receive surgery
and less likely to receive chemotherapy. While surgery may be considered on an individual
basis, increasing efforts to ensure patients with colon or small bowel NECs receive
guideline-concordant chemotherapy will positively impact survival. In addition, interventions
to improve health insurance coverage to increase receipt of chemotherapy are warranted.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
October 16,
2022
Received in revised form:
August 19,
2022
Received:
February 23,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
