Octreotide long-acting repeatable use among elderly patients with carcinoid syndrome and survival outcomes: A population-based analysis

Chan Shen, Ya Chen Tina Shih, Ying Xu, James C. Yao

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged≥65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival. RESULTS Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51%) and 81 of 807 patients with local/regional disease (10%) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.23-0.81), female sex (OR, 0.62; 95% CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95% CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P≤.001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P=.563). CONCLUSIONS The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines. Cancer 2014;120:2039-2049.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalCancer
Volume120
Issue number13
DOIs
StatePublished - Jul 1 2014

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Octreotide
Carcinoid Tumor
Survival
Population
Neuroendocrine Tumors
Odds Ratio
Confidence Intervals
United States Food and Drug Administration
Medicare
Proportional Hazards Models
Vipoma
Logistic Models
Sex Ratio
Diarrhea
Neoplasms
Epidemiology
Retrospective Studies
Databases
Guidelines

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

@article{2a85dacb303c4b94adfa0bb229e05ca7,
title = "Octreotide long-acting repeatable use among elderly patients with carcinoid syndrome and survival outcomes: A population-based analysis",
abstract = "BACKGROUND Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged≥65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival. RESULTS Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51{\%}) and 81 of 807 patients with local/regional disease (10{\%}) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95{\%} confidence interval [95{\%} CI], 0.23-0.81), female sex (OR, 0.62; 95{\%} CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95{\%} CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P≤.001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P=.563). CONCLUSIONS The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines. Cancer 2014;120:2039-2049.",
author = "Chan Shen and Shih, {Ya Chen Tina} and Ying Xu and Yao, {James C.}",
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month = "7",
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Octreotide long-acting repeatable use among elderly patients with carcinoid syndrome and survival outcomes : A population-based analysis. / Shen, Chan; Shih, Ya Chen Tina; Xu, Ying; Yao, James C.

In: Cancer, Vol. 120, No. 13, 01.07.2014, p. 1-11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Octreotide long-acting repeatable use among elderly patients with carcinoid syndrome and survival outcomes

T2 - A population-based analysis

AU - Shen, Chan

AU - Shih, Ya Chen Tina

AU - Xu, Ying

AU - Yao, James C.

PY - 2014/7/1

Y1 - 2014/7/1

N2 - BACKGROUND Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged≥65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival. RESULTS Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51%) and 81 of 807 patients with local/regional disease (10%) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.23-0.81), female sex (OR, 0.62; 95% CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95% CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P≤.001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P=.563). CONCLUSIONS The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines. Cancer 2014;120:2039-2049.

AB - BACKGROUND Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged≥65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival. RESULTS Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51%) and 81 of 807 patients with local/regional disease (10%) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.23-0.81), female sex (OR, 0.62; 95% CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95% CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P≤.001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P=.563). CONCLUSIONS The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines. Cancer 2014;120:2039-2049.

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