The outcomes of patients with neuroendocrine tumors (NETs) may differ based on factors such as socioeconomic status, marital status, and age at diagnosis. Several studies presented at the recent 2025 ASCO Gastrointestinal Cancers Symposium assessed the impact that these factors have on patient survival using data from the Surveillance, Epidemiology, and End Results (SEER) database.

Following these presentations, featured expert Jennifer R. Eads, MD, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Eads on these findings are presented here.

There are 2 different types of disparities in NETs: there are treatment-associated differences, and then there are care-related disparities. For NETs specifically, we have not historically performed next-generation sequencing like what is typically done for some other malignancies because we do not necessarily have drug targets that would ultimately affect how we treat people. Over time, if we learn that there are genetic differences among groups, that could be really helpful, as this could have treatment implications.

At the 2025 ASCO Gastrointestinal Cancers Symposium, Adit Dharia, MD, MBBS, presented a study evaluating care disparities among patients with small intestine carcinoid tumors and reported that income level made a difference in overall patient survival outcomes, with patients earning less than $50,000 having a worse overall survival than those earning $100,000 to $120,000 (abstract 653). We typically recommend that patients with NETs at least seek an opinion at a tertiary center with a neuroendocrine center of excellence. You can imagine that if a patient has a lower income and perhaps lives quite a distance from one of those centers, it may not be an easy undertaking, considering factors such as travel costs and time, and this may lead to a lack of access to care. For a rare disease such as NETs, there definitely seems to be a difference in the quality of care that is received between those who have the means to get an expert level of care and those who are being treated in a more rural setting, where the local oncologist sees perhaps only 1 or 2 patients with NETs each year.

In another study presented at the ASCO symposium, Amy D. Stringer, BS, MS, and colleagues investigated the effects of marital status on NET outcomes (abstract 654). Whenever I see a new patient, I always ask about their support structure, and I find out if they are married or single and if they live alone. Having a support system can be helpful to patients from so many standpoints. For example, it can mean another set of ears in the room so that everybody understands what is being discussed during appointments. In contrast, if a patient comes alone, they may only catch some of what is said, but not all of it. Sometimes patients are more emotional about the whole situation than a family member or friend may be. And so, I think that having an extra person in the room can potentially help with knowledge and with understanding what is happening. Then there are the practicalities of treatment. While patients can take themselves to and from appointments for some treatments without a problem, other treatments require somebody to be there to drive the patient home or to take them to follow-up appointments. I think that receiving care can be prohibitive for people who do not have that type of support, and I am not surprised by the finding from abstract 654 that people fared better if they had a partner. The challenge lies in how we can intervene to improve that.

Udhayvir Singh Grewal, MD, presented a study at the 2025 ASCO Gastrointestinal Cancers Symposium evaluating the outcomes of people diagnosed with early- vs average-onset small bowel NETs and found that early-onset disease was associated with better survival (abstract 670). For small bowel NETs, there is no known inherited syndrome, so why someone would be particularly young when they are found to have this or why they would have improved survival is unclear. Perhaps those with average-onset disease have other additional medical issues that impact survival. Although patients may have inherent qualities that may make them more prone to disparities in care, socioeconomics, fear of the medical system, and access to care all play into it as well.