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Knowledge Gaps in the Treatment of Carcinoid Syndrome

The top 3 ABNS competencies addressed by the educational content.

Optimal management of carcinoid syndrome in patients with neuroendocrine tumors poses a challenge, due to the fact that the primary symptoms of carcinoid syndrome are associated with more common diseases. Because timely recognition is difficult, symptoms of carcinoid syndrome can negatively impact patients' quality of life and functioning.

Baseline data collected from a continuing nursing education (CNE)-approved Oncology Nursing Strategy Session titled Optimizing Management of Carcinoid Syndrome in Patients with Neuroendocrine Tumors revealed knowledge gaps surrounding carcinoid syndrome risk assessment and treatment selection.

The strategy session, which was available online from March 9, 2018, to March 8, 2019, was completed by 655 participants, including 589 registered nurses, 14 nurse practitioners, 1 physician, and 26 others. Participants had an average of 18 years in practice and saw an average of 5 patients with carcinoid syndrome per month. According to the results of pretests administered prior to the activity's commencement, knowledge at baseline was as follows:

  • 31.6% of participants were able to recognize that bradycardia is not a symptom of carcinoid syndrome in a patient diagnosed with a well-differentiated neuroendocrine tumor
  • 67.8% of participants were able to identify bowel obstruction, carcinoid crisis, and carcinoid heart disease as symptoms of carcinoid syndrome
  • 39.5% of patients were able to grade an increase of 5 stools a day over baseline and a moderate increase in ostomy output compared with baseline as grade 2 diarrhea
  • 35.6% of patients were able to identify the addition of telotristat to the current regimen as an effective treatment for a patient who stops responding to monthly octreotide injections for diarrhea
  • 39.8% of patients were able to recognize stomatitis as a likely treatment-related adverse event for a patient receiving everolimus for a neuroendocrine tumor and carcinoid syndrome

Participants answered the same questions upon completion of the activity to determine if their understanding of carcinoid syndrome symptoms and treatment had improved, yielding the following results:

  • 95.9% of participants were able to recognize that bradycardia is not a symptom of carcinoid syndrome in a patient diagnosed with a well-differentiated neuroendocrine tumor
  • 97.9% of participants were able to identify bowel obstruction, carcinoid crisis, and carcinoid heart disease as symptoms of carcinoid syndrome
  • 98.1% of patients were able to grade an increase of 5 stools a day over baseline and a moderate increase in ostomy output compared with baseline as grade 2 diarrhea
  • 70.6% of patients were able to identify the addition of telotristat to the current regimen as an effective treatment for a patient who stops responding to monthly octreotide injections for diarrhea
  • 89.9% of patients were able to recognize stomatitis as a likely treatment-related adverse event for a patient who receives everolimus for a neuroendocrine tumor and carcinoid syndrome

While participant competence in recognizing and managing the symptoms and complications of carcinoid syndrome increased substantially, competence in treatment selection improved but remained suboptimal, indicating an area of educational need. Additionally, gaps between actual practice and evidence-based practice were present. Therefore, further education is needed regarding recognition of carcinoid syndrome symptoms and complications, symptom management, treatment selection, and management of treatment-related adverse events.

Upon completion of the activity, 93% of participants reported that they felt more confident in treating their patients with carcinoid syndrome and that they would use the material presented to improve the outcomes of their patients.

For More Information

i3 Health (2019). Optimizing management of carcinoid syndrome in patients with neuroendocrine tumors: activity outcomes summary report. Data on file. 


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