Are there Reliable Predictors for the Impaired Quality of Life in Patients With Cushing’s Syndrome?

Abstract

Context.Patients with Cushing's syndrome (CS) of any etiology experience a number of physical and psychological symptoms which impact negatively on healthrelated quality of life (HRQoL).Subjects and methods. HRQoL was measured using CushingQoL questionnaire.Results. The first part of our study was a crosssectional analysis of 141 patients with CS over a 10-year period. CushingQoL score was lower in pituitary CS compared to adrenal CS. Remission and older age were associated with better outcome on item 7 (physical appearance anxiety). In a multivariate regression analysis after adjustment for etiology, remission status, age, UFC, duration of hypercortisolism and presence of hypercortisolism-associated comorbidities the female gender was the only negative predictor associated with poorer outcome on each of the three scores. The presence of hypercortisolism-associated comorbidities independently predicted poorer outcome on the psychological and the global subscales.The second part of our research was a prospective study of 27 patients with adrenal adenoma. Achievement of remission independently predicted improvement of the total score of any patient. Conclusion.Studying in details and understanding the mechanisms of the impaired HRQoL in patients with CS is the only way to become aware of the problem and create methods that could help these patients.

Holistic burden of illness in patients with endogenous Cushing's syndrome: A systematic literature review

“…Most studies (30; 81%) reported on prior interventions, including transsphenoidal surgery, adrenalectomy, radiotherapy and pharmacotherapy. Thirty‐two (86%) studies reported HRQoL burden, 12–14,18–30,33–48 4 (11%) studies reported economic burden 15–17,27 and one (3%) study reported both 25 . Eight (22%) studies reported pre−/post‐surgery outcomes 18,19,37,38,42,43,47,48 .…”

“…CS specific HRQoL was evaluated in 18 (49%) studies using three different PRO measures—CushingQoL questionnaire, Tuebingen Cushing's Disease Quality of Life Inventory (Tuebingen CD‐25) and QoL‐Cushing's disease (QoL‐CD) 19,22–24,26,29–31,33–40,42,43,46 . CushingQoL is a 12‐item, CS‐specific HRQoL PRO that examines patients' HRQoL over the past 4 weeks 8 .…”

“…Eight (22%) studies reported pre−/post‐surgery outcomes 18,19,37,38,42,43,47,48 . Thirty‐one (84%) studies reported HRQoL using validated patient reported outcome (PRO) measures 15,16,19,21,23–45,55–57 . A comprehensive list of the PRO measures used to measure the outcomes was recorded (Table A4).…”

“…Following a comprehensive review of the 246 titles and abstracts, 74 (30%) studies were selected for further full‐text review, of which 45 (18% of 246) studies met criteria for qualitative synthesis of the literature (Figure 1 ). 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 Studies were excluded for a variety of reasons throughout the screening process, including but not limited to, the study population, study design or outcomes being out of scope and thus not of interest to the authors (Figure 1 ).…”

“…Thirty-two (86%) studies reported HRQoL burden, [12][13][14][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] 4 (11%) studies reported economic burden [15][16][17]27 and one (3%) study reported both. 25 Eight (22%) studies reported pre−/post-surgery outcomes.…”