Supplementary Material for: Anxiety, Depression and Quality of Life in Neuroendocrine Neoplasm Patients: Insights from Regression and Network Analysis

Background: Neuroendocrine neoplasms (NENs) are rare, heterogeneous malignancies with rising incidence and poor survival outcomes in China. In addition to physical symptoms, NEN patients frequently experience significant psychological distress and reduced quality of life (QOL). However, comprehensive studies on their psychological profiles and QOL are limited.
Methods: 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). Data were analyzed using multivariable regression and network analysis.
Results: A total of 327 patients were included. Notably, 112 patients (34.3%) exhibited significant depressive symptoms and 114 (34.9%) significant anxiety. Non-metastatic NEN patients demonstrated higher anxiety. Survival time, gender, tumor site, and cancer stage 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 (“inability”), the QLQ-GI.NET21 sexual function domain, PHQ1 (“anhedonia”), and GAD7 (“feeling afraid”). Gender and metastatic status did not significantly affect network structure.
Conclusion: 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 provide promising targets for reducing psychological distress in NEN patients.