Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors

Abstract

Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40–90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.

Assessment and State of Nutrition of Patients with Gastroenteropancreatic Neuroendocrine Neoplasms

“…This fact is also confirmed by the qualitative analyses of menus, which confirmed deficiencies in the menus in terms of legumes, wholegrain products, fruit and vegetables, both raw and processed. Similar values were achieved in a study by Gallo et al [7] The exacerbating symptoms in the gastrointestinal tract had an influence on the limitation of fiber consumption, further contributing to the presence of deficiencies of antioxidants, as well as to changes in gut microflora [9,24].…”

“…Moreover, this type of neoplasm often features diarrhea caused by excessive motility of the small intestine, stimulated by the excessive secretion of serotonin precursors [8]. For this reason, GEP-NET patients may present significant problems with the incorrect absorption of nutrients, vitamin deficiency or food intolerance [9]. GEP-NET patients are the group of people that are at the highest risk, therefore, proper nutrition is important for the proper support of treatment and improvement of the patients' quality of life.…”

Role of Diet in the Management of Carcinoid Syndrome: Clinical Recommendations for Nutrition in Patients with Neuroendocrine Tumors

“…As noted by other authors, it cannot be overstated that there is limited information on the nutritional issues faced by patients with CS (31). Moreover, malnutrition, vitamin deficiencies, and food intolerances appear to be prevalent, but unfortunately are not widely recognized (31).…”

“…As noted by other authors, it cannot be overstated that there is limited information on the nutritional issues faced by patients with CS (31). Moreover, malnutrition, vitamin deficiencies, and food intolerances appear to be prevalent, but unfortunately are not widely recognized (31). If these complications are not adequately treated, they can have significant negative impact on quality of life and physical functioning (31).…”

“…Moreover, malnutrition, vitamin deficiencies, and food intolerances appear to be prevalent, but unfortunately are not widely recognized (31). If these complications are not adequately treated, they can have significant negative impact on quality of life and physical functioning (31). Although not widely investigated, the association between nutrition-related complications and quality of life is being examined in a dedicated study in patients with gastroenteropancreatic NETs, and should help to provide a comprehensive description of the nutritional issues that these patients face (32).…”