E158: Analyzing Socioeconomic Status and Outcomes for Neuroendocrine Tumor Patients Treated within a High-Volume Multidisciplinary Care Model

National studies suggest social determinants of health such as race and socioeconomic status (SES) impact survival in metastatic neuroendocrine tumors (NETs). Care delivery within a multidisciplinary clinic (MDC) has been shown to help offset disparities in other cancers, but has not been studied in NETs. Herein, we examine the impact of SES on management strategies and outcomes for patient diagnosed with metastatic NET treated within a high-volume MDC.

Methods: We conducted a retrospective cohort study examining all patients with NET metastatic to the liver who underwent surgical debulking from 2018-2022. Low SES was assessed by the national area deprivation index and was the primary independent variable of interest. Baseline patient characteristics, oncologic features, treatment, and progression-free survival were evaluated.

Results: During the study period, 79 patients evaluated in the NET MDC underwent surgical debulking. Low SES patients (n=28) had longer time from diagnosis to surgery (20.4 vs 9.6 mos, p=0.03), higher rates of unknown primary (14.4% vs 1.9%, p=0.05), and higher-grade disease on presentation (Grade 3: 11% vs 0%; p=0.04). There were no differences in preoperative somatostatin analogue therapy (SSA). However, low-SES patients received more preoperative chemotherapy (25% vs 7.8%, p=0.04). Perioperatively, there were no differences in volume of debulking, blood loss, or major postoperative complications. Low-SES patients had significantly higher rates of readmission (25% vs 2%, p=0.001).  Postoperatively, low SES patients had similar receipt of SSA and p<span class="ykmvie">eptide receptor radionuclide therapy. Following surgery, 94% of patients continued care within the NET MDC with a median follow up of 28.5 months. On surveillance, there was no difference by SES in postoperative progression free survival (Low 28.5 vs High 16.6 mos, p=0.13).

Conclusions: For patients treated within the NET MDC, lower SES was not associated with differential treatment or outcomes. On presentation, Low SES patients had delayed time to surgical debulking with higher grade disease. Postoperatively, Low-SES patients had similar rates of postoperative systemic treatment and progression free survival. Care within an MDC may therefore help eliminate socioeconomic disparities in perioperative care and survival for patients with metastatic NET.