Quality of Life and its Determinants in Patients With Treated Acromegaly: A Cross-Sectional Nationwide Study in China

Abstract

Context Quality of life (QoL) continues to be impaired in acromegaly after treatment. Objective We conducted the first nationwide survey assessing QoL status among Chinese patients with treated acromegaly and explored correlations with clinical parameters, treatment modalities and outcomes. Design Cross-sectional study. Setting Survey via Chinese Association of Patients with Acromegaly (CAPA) online platform. Patients Treated patients from CAPA. Main Outcome Measures QoL was assessed using acromegaly QoL questionnaire (AcroQoL), five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L), and 12-item short-form health survey questionnaire (SF-12). Results Complete, valid questionnaires from 327 patients (mean age: 39.2 years, 61.5% females) at a mean of 10 years after treatment were included. Biochemical control was satisfied in 52.9% of these patients. The controlled patients had significantly better QoL than the uncontrolled patients in all AcroQoL dimensions, most SF-12 dimensions, and pain/discomfort and anxiety/depression dimensions of the EQ-5D-5L. Patients with either controlled or uncontrolled acromegaly had significantly worse QoL than the age- and sex-adjusted population reference in most SF-12 dimensions except for physical functioning. More acromegaly-associated symptoms and comorbidities at follow-up were independent risk factors for decreased QoL across all questionnaires. Medical treatment, especially with somatostatin analogs (SSAs), and radiotherapy were predictors of worse QoL. Female patients had lower scores of physical-related QoL than male patients. Conclusions Our study suggests that biochemical control improved but did not normalize QoL in acromegaly. Numbers of symptoms and comorbidities at follow-up, sex, radiotherapy, and medical treatment with SSAs were factors determining QoL of patients with treated acromegaly.

The Effect of Aging on Quality of Life in Acromegaly Patients Under Treatment

“…In this study, we showed that the factors associated with impaired AcroQoL were significantly different for various age groups. For young and middle-aged patients, treatment modalities including current medical therapy and past radiotherapy impaired the QoL score, as shown in previous reports ( 13 , 14 ). In contrast, treatment modalities did not affect the AcroQoL of older patients.…”

“…In a study of a healthy population using Short From-36 (SF-36), a widely used general health-related QoL questionnaire, QoL declined with age as a result of declines in physical, mental, and social functions ( 12 ). In a study using the AcroQoL questionnaire, a disease-specific questionnaire for acromegaly, some factors, including therapeutic modalities such as radiotherapy and drug therapy, symptoms such as headache and joint pain, and poor body image, contributed to poor QoL scores ( 13 , 14 ). We have previously developed a Japanese version of AcroQoL and showed that acromegaly patients with surgical remission have better QoL scores than young and middle-aged patients receiving medical treatment or radiotherapy ( 15 ).…”

Variables Associated With Body Image Concerns in Acromegaly Patients: A Cross-Sectional Study

“…It is worth noting that, combining the findings of the literature and clinical experience (Tiemensma et al, 2010;Zimmermann et al, 2018;Wolters et al, 2020;Guo et al, 2021), we also hypothesized at the beginning of the study that there was a correlation patients ' between hormone levels and psychology. However, only PRL, ACTH, and postoperative growth hormone levels were statistically significant in the univariate analysis, and the results of multiple linear regression showed no association between hormone levels and psychology.…”

Patient-Identified Problems and Influences Associated With Diagnostic Delay of Acromegaly: A Nationwide Cross-Sectional Study

“…Furthermore, the findings implied that the substantial adverse outcomes of elevated GH levels at diagnosis and subsequent endocrine-metabolic (except diabetes), musculoskeletal and cardiovascular comorbidities were associated with diagnostic delay. The increased comorbidities may reduce quality of life of the patients ( 27 ) and increase their mortality ( 28 , 29 ). This result is similar to the findings from the study using Swedish registry data ( 9 ) that patients with longer diagnostic delay tended to have more musculoskeletal, endocrine-metabolic and cardiovascular comorbidities in univariate analysis, while the pattern of respiratory disease prevalence across different length of diagnostic delay was unclear.…”