Pre-existing Symptoms and Healthcare Utilization Prior to Diagnosis of Neuroendocrine Tumors: A SEER-Medicare Database Study

Abstract

The incidence and prevalence of neuroendocrine tumors (NETs) are continually increasing. While it is known that NET symptoms often predate diagnosis, their prevalence and impact on resource utilization and costs are largely unknown. We identified 9,319 elderly patients diagnosed with NETs between 1/2003 and 12/2011 from the Surveillance, Epidemiology and End Results (SEER)-Medicare. We examined the patients’ conditions potentially associated with NET, resource utilization and costs during the year before diagnosis. We found that NET patients were more likely to have diagnoses of hypertension (63.8% vs. 53.3%), abdominal pain (22.2% vs. 7.6%), heart failure (11.7% vs. 8.0%), diarrhea (5.8% vs. 1.8%), peripheral edema (5.4% vs. 3.8%) and irritable bowel syndrome (1.2% vs. 0.5%) compared to the non-cancer control group. They also had much higher resource utilization including number of outpatient visits (mean: 22.1 vs. 17.2), percentage with ER visits (20.9% vs. 11.6%), and hospitalizations (28.4% vs. 17.0%). Similarly, NET patients incurred significantly higher total (mean: $14602 vs. $9464), outpatient (mean: $5987 vs. $4253), and inpatient costs (mean: $8615 vs. $5211). This first population-based study on the pre-diagnosis symptoms and healthcare utilization found that NET patients were more likely to have certain conditions and incur higher resource utilizations and costs.

The clinical applications of a multigene liquid biopsy (NETest) in neuroendocrine tumors

“…NET diagnosis and management in the USA is associated with significant and consistent resource use irrespective of tumor site or grade [ 92 – 94 ]. In the year prior to a formal NET diagnosis, ~USD$14,000 will be spent on identifying the disease, the majority of which is expended on biomarkers and imaging [ 94 ]. A newly diagnosed NET patient pays on average $40,100 in the first year of the disease, excluding somatostatin analogue costs ($60–70,000/year) [ 93 ].…”

Exploration of Machine Learning Techniques to Examine the Journey to Neuroendocrine Tumor Diagnosis with Real-World Data

“…Prior studies of the pathway to NET diagnosis have either relied on patient memory (survey studies), focused on the 12 months immediately preceding diagnosis, or describe singular patient characteristics, but all report that misdiagnosis and delayed diagnosis are common with NET [15][16][17][18]30]. Early symptoms of NET, including pain, diarrhea and fatigue, are nonspecific and common to a range of less severe conditions [15,16].…”

“…Both likely increase the economic burden of NETs. For example, among Medicare beneficiaries, healthcare spending in the year preceding NET diagnosis was 54% higher among patients with NET than among noncancer controls [30].…”

Role of Combined 68Ga DOTA-Peptides and 18F FDG PET/CT in the Evaluation of Gastroenteropancreatic Neuroendocrine Neoplasms

“…However, the combined use of CI and functional imaging, using 111 In-Pentetreotide SPECT/CT, still leaves a big gap in the diagnostic pathway [24]. Therefore, newer, higher-affinity SST analogs, labeled with radioisotopes with better resolution and dosimetry, such as 68 Ga, which is a positron emitter, have been considered as promising SSTR imaging agents.…”