Anxiety, Depression and Quality of Life in Neuroendocrine Neoplasm Patients: Insights from Regression and Network...

Neuroendocrine neoplasms (NENs) are rare, heterogeneous malignancies with increasing incidence and poor survival in China. Beyond physical symptoms, patients frequently experience psychological distress and impaired quality of life (QOL), yet comprehensive evidence remains limited.

Patients with NENs were recruited from the oncology outpatient clinic at Fudan University Shanghai Cancer Center. Psychological status and QOL were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Questionnaire-7 (GAD-7), and the Quality-of-Life Questionnaire-Gastrointestinal Neuroendocrine Tumors-21 (QLQ-GI.NET21). Multivariable regression and network analysis were performed.

Among 327 patients, 34.3% exhibited significant depressive symptoms and 34.9% anxiety. Nonmetastatic NEN patients showed higher anxiety, although this finding should be interpreted with caution. Survival time, gender, tumor site, and disease phase significantly influenced anxiety and depression scores. In the gastrointestinal subgroup, G3-grade patients experienced greater distress and poorer QOL. Network analysis revealed a complex interrelationship among anxiety, depression, and QOL dimensions. High-centrality nodes included GAD2 ("uncontrollable worry"), the QLQ-GI.NET21 social function domain, GAD5 ("restlessness"), PHQ9 ("suicide"), and PHQ4 ("fatigue"). Key bridge symptoms were identified as PHQ2 ("sad mood"), GAD5 ("restlessness"), the QLQ-GI.NET21 sexual function domain, PHQ1 ("anhedonia"), and GAD7 ("feeling afraid"). Gender and metastatic status did not significantly affect network structure.

These findings underscore the need for integrated psychological assessments and tailored interventions throughout treatment, particularly for high-risk subgroups. The core symptoms and bridge nodes identified may serve as potential targets for reducing psychological distress in NEN patients.