Predictors of Quality of Life in 165 Patients With Acromegaly

Results From a Single-Center Study

Ilonka Kreitschmann-Andermahr, MD; Michael Buchfelder, MD; Bernadette Kleist, CN; Johannes Kohlmann, MD; Christa Menzel, RN; Rolf Buslei, MD; Maria Kołtowska-Häggström, MD; Christian Strasburger, MD; Sonja Siegel, CP

Disclosures

Endocr Pract. 2017;23(1):79-88. 

In This Article

Results

Descriptive Statistics

The clinical characteristics of the study population are shown in Table 1 and are reported in more detail elsewhere.[11] The mean scores (SD) of the SF-36, BDI-II, and BEI are presented in Table 2. Overall, in our study, 31.6% of patients reported an impaired physical component of QoL: 21 patients (13.5%) presented with an SF-36 PCS score below −2 SDS of the mean, and 28 patients (18.1%) scored −1 SDS below the mean. With regard to the mental QoL component, the corresponding proportion of patients was similar: 38 patients (24.5%) presented with an SF-36 MCS score below −2 SDS of the mean, and 17 patients (11.0%) presented with a score −1 SDS below the mean.

According to the BDI-II, no depressive symptoms were observed in 92 patients (56.8%), minor depressive symptoms in 27 patients (16.7%), and mild depressive symptoms in 16 patients (9.9%). Clinically relevant depression, with moderate or severe depressive symptoms, was observed in 20 patients (12.3%) and 7 patients (4.3%), respectively.

The total BEI scores indicated a low degree of embitterment in 80 patients (49.1%), a medium degree of embitterment in 53 patients (32.5 %), an above-average degree of embitterment in 26 patients (16.0%), and an extreme degree of embitterment in 4 patients (2.5%).

There were no differences between responders and nonresponders in terms of age (46.11 ± 11.65 years vs. 50.3 ± 10.6 years, respectively; P>.05) or sex distribution (50.3% males among respondents vs. 54.3% males among nonrespondents; P>.05).

Correlation Analyses

A lower SF-36 PCS score (indicating poorer physical QoL) was correlated to: older age at diagnosis and age at study entry; longer latency from first seeking advice to diagnosis and from symptom onset to diagnosis; a higher number of doctors visited; a longer time from symptom onset to last surgery; current unemployment; and, a higher BMI (all P<.001). A lower SF-36 MCS score (indicating poorer mental QoL) correlated to: a higher number of doctors visited and a positive history of radiotherapy (both P<.001); female sex (P = .007); and younger age at study entry (P = .023). More severe depression, as indicated by higher BDI-II values, was correlated to: younger age at study entry (P = .026); female sex (P = .003); a longer time from first seeking help to diagnosis (P = .004); a higher number of doctors visited; previous radiotherapy (both P<.001); and current unemployment (P = .010). Finally, a more profound level of embitterment, as shown by higher BEI scores, correlated with a younger age at study entry (P = .012); number of doctors visited (P = .018); previous radiotherapy (P = .034); and smoking (P = .031). For a detailed overview of the correlation analyses, see Supplementary Table S1.

Regression Analyses

A detailed breakdown of the final regression models is shown in Table 3.

Prediction of Physical QoL

For poorer physical QoL, as measured by the SF-36 PCS score, the predictor with the highest amount of explained variance (ΔR2 = 0.219) was longer latency between first presentation and diagnosis with a BETA of −0.240, indicating the negative relationship between these two parameters. This predictor was followed in strength by higher BMI, a higher number of doctors visited, and older age at diagnosis. Taken together, these four predictors explained 38.5% (R2 = 0.385; see Table 3) of the variability of poor physical QoL in the patients studied.

Prediction of Mental QoL

A higher number of doctors visited was the predictor with the highest amount of explained variance (ΔR2 = 0.143) for poorer mental QoL, followed by having received radiotherapy during the course of the disease and younger age at study entry. Taken together, these variables explained 23% (R2 = 0.230) of the variability of poor mental QoL in the patients studied.

Prediction of Depression

The predictor with the highest amount of explained variance for depression (BD-II) in our patients was a higher number of doctors visited (ΔR2 = 0.176). This was followed in strength by a positive history of radiotherapy, younger age at study entry, and current unemployment. Together, these predictors explained 31.2% (R2 = 0.312) of the variability of being depressed in the investigated patients.

Prediction of Embitterment

A higher BEI total score was predicted by a higher number of doctors visited and a younger age at study entry. With only 7.5% (R2 = 0.075), the explained variance was low for this regression model.

processing....