Treatments and ongoing monitoring for patients with neuroendocrine tumors, monitored by medical oncologists: Scan comparative data between advanced economies (AE) and emerging and developing economies (EDE).
Authors: Rodien-Louw Christine , McDonnell Mark , Kolarova Teodora , Bouvier Catherine , Pavel Marianne E , Hicks Rodney J. , Chen Jie , Singh Simron , Van Genechten Dirk , O'Toole Dermot , Gellerman Elyse , Dureja Sugandha , Leyden Simone , Howe James R. 
Published: June 2021

e16200

Background: The Survey of Challenges in Access to Diagnostics and Treatment for NET Patients (SCAN) measured the delivery of healthcare to neuroendocrine tumor (NET) patients globally. This analysis focused on the treatments and follow-up received by NET patients who most often visited a medical oncologist (MO) for their ongoing monitoring, and compared results between Advanced Economies (AE) and Emerging and Developing Economies (EDE). Methods: During Sept-Nov 2019, 2359 NET patients and 436 healthcare professionals (HCPs) from 68 countries completed an online self-report survey, available in 14 languages, disseminated by NET patient group networks, NET medical societies and other INCA partners. Results: 1016 NET patients (43% of all NET patients globally) reported a MO as the HCP most often visited for their ongoing monitoring, 90% of which were from AE (N = 913) and 10% from EDE (N = 103). 108 MOs (25% of all HCPs) took part in the survey, 62% from EDE [67/108]. Primary NETs for this patient sub-group were most often GEP NETs, specifically small intestine, more often reported from AE (41%, 316/913) than EDE (20%, 21/103; p < 0.0001 by Chi-square), and pancreatic, more often reported from EDE (33%, 34/103) than AE (21%, 192/913). Other primary NETs included lung (AE [11%, 92/913], EDE [6%, 6/103]) and of unknown origin (AE [8%, 73/913], EDE [14%, 14/103]). The most common treatment received was somatostatin analogues (SSA) (AE [57%, 507/913], EDE [44%, 43/103]), followed by surgery (AE [16%, 140/913], EDE [17%, 16/103]) and oral chemotherapy (AE [14%, 120/913], EDE [18%, 17/103]). PRRT (AE [14%, 124/913], EDE [8%, 8/103]; p < 0.0001) was used more frequently in AE. Awareness of the 4 most frequently used treatments among MOs was 80% or greater. MOs reported similar availability of SSA (AE [95%, 39/41], EDE [96%, 64/67]) by economic areas, while lower availability of surgery (AE [98%, 40/41], EDE [88%, 59/67], oral chemotherapy (AE [98%, 40/41], EDE [82%, 55/67]) and PRRT (AE [81%, 33/41], EDE [60%, 40/67]; p < 0.0001) in EDE. NET patients reported CT scan as the most frequently used ongoing monitoring tool (AE [78%, 699/913], EDE [70%, 66/103]). Ga-68-labeled SSA PET/CT was used for slightly more than 1/3 of patients with no significant differences by regions (AE [38%, 337/913], EDE [30%, 28/103]). For these tools, awareness among MOs was 69% and above, while both awareness and availability were significantly lower in EDE. Multidisciplinary teams (MDT) were rarely used in AE NET patients (35%, 318/913), and in only 14% (14/103) of EDE. Conclusions: MOs play an essential role in NET patients’ follow-up, being the leading HCP for almost half of them. There is a critical need for a global standard of ongoing NET monitoring as data indicate significant differences in therapeutic and follow-up procedures between AE and EDE.