Psycho-Oncological Screening Identifies High-Risk Subgroups Among Neuroendocrine Tumor Patients Undergoing PRRT with [177Lu]Lu-DOTATATE: Implications for Survival

Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies characterized by variable clinical presentations and significant psychological burdens. Peptide receptor radionuclide therapy (PRRT) with [¹⁷⁷Lu]Lu-DOTATATE is a cornerstone in managing somatostatin receptor-positive NETs. This study investigates the role of psycho-oncological screening using the Hornheider Screening Instrument (HSI) in identifying psychosocial distress and its impact on overall survival (OS) and progression-free survival (PFS) in NET patients undergoing PRRT.A cohort of 100 NET patients with progressive disease scheduled for PRRT was retrospectively analyzed. All patients underwent psycho-oncological screening before PRRT using HSI. Patients were stratified into four groups, based on their screening results and acceptance or refusal of psycho-oncological support. Clinical outcomes, including PFS and OS, were assessed, and subgroup analyses were performed to identify potential predictors of survival.Among 38 patients identified as needing psycho-oncological support, 9 accepted and 29 declined treatment. Patients who accepted psycho-oncological care demonstrated a 100% survival rate, comparable to patients with no significant distress. In contrast, patients who declined care exhibited a significantly shorter OS (median 83.7 months) and a higher death rate (38%). No differences were observed in PFS across groups. Subgroup analysis revealed similar tumor grading, pretreatment, and therapeutic regimens, suggesting that psychosocial factors influence OS independent of disease progression. Notably, women were more likely to accept psycho-oncological support than men.Psycho-oncological distress significantly impacts OS in NET patients undergoing PRRT. Acceptance of psycho-oncological care was associated with improved survival, highlighting the importance of integrating psychological support into routine NET management. These findings underscore the need for tailored psycho-oncological interventions, especially for patients at high risk who decline care. Further studies are warranted to elucidate the mechanisms linking psychosocial factors with clinical outcomes.