Table 1.

Selected commonly used medications, integrative treatments, procedures, and NET-directed treatments in people with symptom-related NET.

Treatment type (✓ if relatively specific to palliation of NET)	Intervention	Typical indication in people with NET
Symptom management with medications	Opioids	Pain
	Co-analgesics (e.g. gabapentin, pregabalin, SNRIs, TCAs)	Pain, neuropathic pain
	Stimulants (e.g. methylphenidate, modafinil)	Fatigue
	Antidepressants (Nobels et al. 2016): (e.g. SNRIs (venlafaxine, duloxetine), SSRIs, mirtazapine)	Depression
	Anxiolytics (e.g. ativan)	Anxiety
✓	Carcinoid syndrome management medications: somatostatin analogs (Modlin et al. 2010): (e.g. octreotide sq/IM, lanreotide IM), telotristat (Pavel et al. 2018)	Diarrhea
✓	Ursodiol	Diarrhea from bile acid malabsorption
✓	Pancreatic enzyme replacement	Diarrhea from pancreatic insufficiency
	General anti-diarrheal (e.g. loperamide, diphenoxylate & atropine, tincture of opium)	Diarrhea
	Anti-emetics (e.g. ondansetron, prochlorperazine, olanzapine, mirtazapine)	Nausea & vomiting
	Appetite stimulants (e.g. mirtazapine)	Anorexia, weight loss
✓	Gut antibiotics (e.g. rifaximin)	GI distress from bacterial overgrowth
	Bronchodilators	Wheezing
Integrative practices	Acupuncture	Pain, nausea, fatigue
	American ginseng	Fatigue
	Medical cannabis (THC strain especially for appetite stimulation; CBD strain especially for anxiety, insomnia, and neuropathic pain)	Anorexia, nausea, anxiety, pain
	Massage	Pain
	Ice/heat	Pain
	Relaxation	Pain, anxiety
	Exercise	Fatigue, pain
✓	NET nutritional interventions (Artale et al. 2020): avoiding amines and serotonergic foods; supplementing for vitamin deficiencies	Carcinoid syndrome or malabsorption symptoms
Palliative procedures	Surgery	Debulk or remove sites of tumor-causing symptoms
	Paracentesis	Ascites
	Thoracentesis	Pleural effusions
	Biliary stenting	Hepatic obstruction
	Gastric decompression (e.g. with nasogastric tube)	Partial small bowel obstruction
NET-directed treatments (management of disease-causing symptoms)	Chemotherapy (e.g. capecitabine, temozolomide, 5-fluorouracil, streptozocin, doxorubicin)	Pain, diarrhea
	Targeted therapy (e.g. everolimus (mTOR inhibitor), sunitinib (tyrosine kinase inhibitor))	Pain, diarrhea
	Immunotherapy (e.g. interferon alfa-2b)	Pain, diarrhea
✓	Peptide receptor radionuclide therapy (PRRT)	Pain, diarrhea
	Radiation	Pain, diarrhea
	Surgery (Goretzki et al. 2018, Hallet et al. 2021)	Pain, diarrhea
✓	Radiofrequency ablation (RFA)	Pain
✓	Hepatic artery embolization	Pain

SNRI, selective serotonin norepinephrine reuptake inhibitors; SSRI, selective serotonin reuptake inhibitors; TCA, tricyclic antidepressants.