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  • 1.
    Hedendahl Filipsson, Tobias
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    How effective is the treatment of gastroenteropancreatic neuroendocrine carcinoma outside Centers of Excellence?2017Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background and objective

    Neuroendocrine carcinoma (NEC) is rare and highly aggressive form of cancer that is treated by chemotherapy. NEC patients should receive chemotherapy as soon as possible after diagnosis but research on how to treat NEC and the development of treatment guidelines are mainly done at clinics specialized in neuroendocrine cancers called Centers of Excellence (CoE). Before initiating treatment, cases are often discussed at a multidisciplinary team meeting (MDTM). Regional clinics can discuss cases at a MDTM with a CoE, which should help to decide the best available treatment. However, since research outside CoE is limited, it is unknown how often NEC cases are discussed at MDTM. This may affect how they are treated and how effective this treatment is. To investigate this, we reviewed patient records in an unselected population.

    Methods

    Data was collected from the Swedish Cancer Registry. A total of 553 patients with neuroendocrine neoplasm (NEN) from the Northern region of Sweden were included and analysed retrospectively to identify patients with NEC diagnosed over a 17-year period (1997-2014).

    Results

    We found that treatment guidelines were followed in most cases but that a discussion at a MDTM was often lacking. In Västerbotten, 72% of NEN patients were discussed at a MDTM compared to only 40% in other counties. However, the number of cases discussed at MDTM had an increasing trend over time from 26% in 2007 to 60% in 2014 (p = 0.002). Patients with NEN discussed at a MDTM had a significant better overall survival (p < 0.001) than those that were not. Patients with NEC that received chemotherapy had a significant better overall survival (p < 0.001) compared to patients with NEC that received best supportive care (39.8 months vs 3.7 months).

    Conclusions

    In this cohort, patients with NEC had similar clinical outcomes to those reported in other studies. The overall survival for patients in this unselected population was not inferior to that of patients treated at a CoE. When discussed at a MDTM, most patients received the best available treatment according to the current guidelines, resulting in a significantly better overall survival. The number of patients discussed yearly at a MDTM increase significantly over the study period. However, the potential for improvement exists to reach the goal of >80% of cases being discussed. This would enable further patients to have access to best available treatment and the best possible clinical outcome.

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