Evaluation of Nurse Preferences Between the Lanreotide Autogel New Syringe and the Octreotide Long-Acting Release Syringe: An International Simulated-Use Study (PRESTO).

INTRODUCTION: Somatostatin analogues are used to treat symptoms and slow tumour progression in patients with neuroendocrine tumours (NETs) and carcinoid syndrome and to reduce hormone secretion and pituitary tumour volume in patients with acromegaly. A new syringe for lanreotide autogel/depot (LAN) was developed following feedback from a human factors study to improve ease of injection compared with previous syringes. PRESTO aimed to assess preferences of nurses between the LAN new syringe and the octreotide long-acting release (LAR) syringe. METHODS: PRESTO, a multinational, multicentre, prospective, noninterventional, simulated-use study, enrolled nurses with ≥ 2 years' experience injecting LAN and/or octreotide LAR in patients with NETs and/or acromegaly. Nurses administered injections into pads using the LAN new syringe and octreotide LAR syringe in a randomised sequence. In an anonymous web-based questionnaire, nurses reported their overall preference ('strong' or 'slight'; primary endpoint) and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). RESULTS: Overall, 90 nurses attended sessions and completed valid questionnaires. Most nurses (97.8%) expressed a preference (85.6% 'strong', 12.2% 'slight') for the LAN new syringe versus the octreotide LAR syringe (P < 0.0001). Attribute performance ratings (1 [not at all] to 5 [very much]) were consistently higher for the LAN new syringe versus the octreotide LAR syringe, with the greatest differences in 'fast administration' and 'confidence the syringe will not be clogged' (mean difference [SD]: 2.6 [1.2] and 2.3 [1.5], respectively; P < 0.0001). The attribute ranked most important was 'confidence the syringe will not be clogged' (24.4%); least important was 'convenience of syringe format, including packaging, from preparation to injection' (34.4%). CONCLUSIONS: Nurses preferred the user experience of the LAN new syringe compared with the octreotide LAR syringe, with a particular preference for attributes related to product delivery with the LAN new syringe.

Neuroendocrine Tumors and Lanreotide Depot: Clinical Considerations and Nurse and Patient Preferences.

BACKGROUND: Somatostatin analogs (SSAs) are a mainstay therapy for the treatment of carcinoid syndrome associated with neuroendocrine tumors (NETs). They are effective for a range of gastroenteropancreatic NETs (GEP-NETs). Lanreotide depot (Somatuline®) is an SSA that is approved for the treatment of GEP-NETs to improve progression-free survival (PFS). OBJECTIVES: The article reviews the efficacy, safety, and administration of lanreotide depot and relates those attributes to considerations and preferences of oncology nurses and their patients. METHODS: A review of the literature on the use of lanreotide for the treatment of NETs and carcinoid syndrome was conducted. In addition, the literature on drug delivery and routes of administration was surveyed to provide context for comparative studies related to clinical and patient preferences. FINDINGS: Lanreotide depot prolongs PFS and is well tolerated by patients who expressed satisfaction in the ability to control symptoms related to carcinoid syndrome. Nurses cited several benefits to using lanreotide depot in the clinical setting, including more time saved to address other patient care issues. Attributes of lanreotide depot-including its efficacy, safety and tolerability, dosing and administration, and cost-may contribute to healthcare decisions regarding the treatment and management of NETs.

Gastroenteropancreatic neuroendocrine tumours: an overview.

Gastroenteropancreatic neuroendocrine tumours (GEP-NET) represent a heterogeneous family of diseases of often challenging clinical management. Although many GEP-NET are slow progressing and frequently less aggressive than neoplasms of other origin, they can metastasise and reduce the life span of the patient. GEP-NET can be functioning (secreting hormones that may cause symptoms and organ damage), but some 60% are non-functioning. Thorough clinical assessment including family history, biochemical tests, radiology and nuclear medicine scans, and histological confirmation are important to tailor the optimal treatment of GEP-NET, which should be managed with a multidisciplinary approach and mainly guided by tumour grading and staging, functioning status, and location of the primary lesion.

Review of a home nursing injection service: SHINE.

The SHINE home injection service is part of a patient support program run by Novartis. SHINE is for people prescribed octreotide long-acting release (Sandostatin LAR) for neuroendocrine tumours (NETs) and acromegaly. SHINE has been running in Australia since 2009. The service is run by a third-party and administered by homecare (SHINE) nurses. Five hundred people with NETs or acromegaly have been involved since the service started. We review our collective experience of the benefits of SHINE, and make recommendations for future development. We hope this review provides guidance for developing future home injection service.

Update on the management of neuroendocrine tumors: focus on somatostatin antitumor effects.

Although neuroendocrine tumors (NETs) have been recognized as a family of complex malignancies since 1907, major progress has been made only in the past 20 years in understanding and managing the disease. The detection and reported incidence of NETs have increased fivefold since 1973, suggesting that the tumors may be more common than previously believed. NETs arise predominantly in the gastrointestinal tract but can occur in any tissue containing endocrine precursor cells and can secrete hormone peptides that exert clinical symptoms of flushing and diarrhea. With the introduction of the somatostatin analog (SSA) octreotide in 1987, symptom management of NETs improved by diminishing morbidities and mortality associated with carcinoid syndrome. Clinical results suggest that the SSA agents octreotide and lanreotide also may provide antitumor benefits in addition to their suppression of carcinoid syndrome. Oncology nurses should be aware of the expanded role of SSA agents for symptom management and tumor control in patients with NETs and communicate treatment benefits, side-effect management, and effective adherence with patients for the optimal clinical management of NETs.

[Case report: the practical use of the self-care deficit nursing theory for a patient with a neuroendocrine cancer of the duodenum]. / Fallstudie: Praktische Anwendung der Selbstpflegedefizit-Theorie bei einem Patienten mit neuroendokrinem Karzinom des Duodenums.

This case describes the nursing care of a 66-year-old electively admitted patient who came to hospital for the treatment of a hepatic secondary neuroendocrine duodenum cancer. A typical liver resection with duodeno-pancreatectomy and sigmaresection was performed. Complications led to more than ten re-laparatomies with resection of the stomach and oesophagus. It was necessary to perform blind occlusion of the jejunum and the disposition of an oesophagus stoma. A diabetes mellitus was caused by the total resection of the pancreas. Mister B. got a percutaneous endoscope jejunostomy but it could not be used because of a new small intestine fistula into the abdominal cavity wherefore a port was implanted. The following different conceptions of the self-care deficit theory have been used to describe and analyse the patient situation as follows: Basic conditioning factors, self-care requisites, therapeutic self-care demands, self-care competence. The future self-management capabilities consist of the following: Care of the oesophagus stoma, care of the percutaneous endoscope jejunostomy, management of the diabetes mellitus, coping with the changed self-image, coping with the restriction of movement and with the needed prophylaxis. Support was given by the transfer of knowledge to the patient. Instructions were given during realisations of new activities and development of skills. It was evaluated if the patient is capable to reflect his actions and to assess if he is able to react on deviations from the normal standards in a correct and appropriate way. After dismissal it was secured by phone call that the patient successfully manages the new self-care demands independently.

Gastrointestinal stromal tumors and neuroendocrine tumors.

OBJECTIVES: Patients with rare gastrointestinal (GI) malignancies can exhibit unique objective and subjective manifestations. This article is a primer for the fundamental understanding of some of these diseases, namely gastrointestinal stromal tumors (GIST) and gastroenteropancreatic neuroendocrine tumors (NET) and therapeutic strategies. DATA SOURCES: Epidemiologic data, published research reports, national guidelines for oncology practice, and personal experience. CONCLUSION: Despite the rarity of GIST, gastroenteropancreatic neuroendocrine tumors, gastric lymphoma, and adenocarcinoma of the small bowel, oncology nurses must be prepared to effectively assess, plan, and implement care strategies for these patients. IMPLICATIONS FOR NURSING PRACTICE: Caring for patients with uncommon GI malignancies is challenging for oncology nurses whose experience with these tumors is limited. Fundamental knowledge and awareness of resources can help to ensure optimal patient care. Case vignettes illustrate patient presentation and formulation of treatment recommendations.

Nurse developments in neuroendocrine tumour management.

Nurse developments in the management of neuroendocrine tumours have changed significantly over the past three years. At the Royal Free Hospital we set up the nurse specialist role due to the expansion of patients being referred to the specialist unit, and the obvious need for a nursing input into their care. The nurse specialist can make a significant contribution within the context of a multidisciplinary team especially in the production of guidelines and policies to ensure and maintain high standards of practice, education for the patient, and the provision of expertise and security that the patient requires when diagnosed with a rare disease.