Elderly patients with neuroendocrine tumors (NETs) may incur greater costs of care due to carcinoid syndrome, particularly among patients during year 1, according to a study published in The Oncologist.

The production of hormonal peptides by NETs may lead to carcinoid syndrome, which is characterized by symptoms such as flushing, wheezing, diarrhea, and fibrotic valvular heart disease. As the incidence of NETs, and subsequently carcinoid syndrome, have been increasing, the study authors investigated the effect that carcinoid syndrome may have on costs of care.

For this study, researchers identified 6749 elderly patients with NETs from the SEER Medicare database who had at least 2 claims indicative of carcinoid syndrome 3 months prior to or post diagnosis of NETs. Of the enrolled patients, 5633 patients were alive after the first year of diagnosis, and 1116 patients had died.  Among surviving patients, 1189 patients had carcinoid syndrome, and among patients who died, 296 patients had carcinoid syndrome.

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Patients with carcinoid syndrome who survived year 1 had a significantly higher median monthly cost ($3802) compared with patients who did not develop the adverse effect ($2481; P <.0001). Median inpatient costs were $2254 and $1625 in patients with and without carcinoid syndrome, respectively, and median outpatient costs were $1151 and $679, respectively (P <.0001).

Even after multivariable analyses, patients with carcinoid syndrome who survived year 1 had higher total, inpatient, and outpatient costs (P <.005). Among the patients who did not survive past year 1, the association with cost and carcinoid syndrome were no longer significant.

Overall, the results of the study suggest that patients with NETs who develop carcinoid syndrome incur significantly higher costs compared with patients who do not, and the study authors added that “such information may help stakeholders in the health care industry to efficiently allocate resources for NET patients.”


Shen C, Chu Y, Halperin DM, et al. Carcinoid syndrome and costs of care during the first year after diagnosis of neuroendocrine tumors among elderly patients [published online June 22, 2017]. Oncologist. doi: 10.1634/theoncologist.2017-0149