Management of neuroendocrine tumours in metropolitan and regional South West Victoria

Abstract

Aims: To examine the demographic characteristics and geographic distribution of neuroendocrine tumour (NET) diagnoses in South West Victoria, Australia. Method(s): An examination of NET diagnoses from 2009 to 2016 was conducted using the Evaluation of Cancer Outcomes Barwon South West (ECOBSW) database. The database contains demographic and clinical details of new cancer cases in the Barwon South West region, an area encompassing Geelong to the South Australian border. Locality was defined using the Australian Statistical Geography Standard Remoteness Structure, based upon the classification of the Accessibility and Remoteness Index of Australia. Result(s): The ECOBSW cohort includes 233 newly diagnosed NETs, with a crude incidence rate of 7.66 per 100 000 persons per year. The mean age at diagnosis was 67, with more males (55%) than females (45%). Fifty-nine per cent resided in a major city, 34% and 7% from inner and outer regional areas, respectively. NET primary site included gastroenteropancreatic (47%), thoracic (22%), Merkel cell carcinomas (MCC) (18%) and others (13%). Mean survival was similar across all groups: major city 32.5 months, inner regional 32.3 months and outer regional 31.6 months. At last follow-up, percentage mortality was greatest for outer regional (58%) and similar for major city (38%) and inner regional cases (39%). Mean time to first treatment was shortest for major city cases (23 days), followed by inner regional (41 days) and outer regional cases (136 days). The proportion of MCC cases increased with remoteness: 29% outer regional, 20% inner regional and 14% in major city. Conclusion(s): The incidence of NETs in this cohort exceeded the Australian annual incidence which was 3.3 per 100 000 persons/year from 2000 to 2006. Mortality and survival were similar in the major city and inner regional groups, which may reflect regional expertise in the management ofNETs. Increasing education for regionally based oncologists may improve outcomes for other regional areas.