Abstract
Quality of life (QoL) in patients with acromegaly is reduced irrespective of disease state. The contributions of multifactorial determinants of QoL in several disease stages are presently not well known. To systematically review predictors of QoL in acromegalic patients. Main databases were systematically searched using predefined search terms for potentially relevant articles up to January 2017. Inclusion criteria included separate acromegaly cohort, non-hereditary acromegaly, QoL as study parameter with clearly described method of measurement and quantitative results, N ≥ 10 patients, article in English and adult patients only. Data extraction was performed by two independent reviewers; studies were included using the PRISMA flow diagram. We identified 1,162 studies; 51 studies met the inclusion criteria: 31 cross-sectional observational studies [mean AcroQoL score 62.7 (range 46.6-87.0, n = 1,597)], 9 had a longitudinal component [mean baseline AcroQoL score 61.4 (range 54.3-69.0, n = 386)], and 15 were intervention studies [mean baseline AcroQoL score 58.6 (range 52.2-75.3, n = 521)]. Disease-activity reflected by biochemical control measures yielded mixed, and therefore inconclusive results with respect to their effect on QoL. Addition of pegvisomant to somatostatin analogs and start of lanreotide autogel resulted in improvement in QoL. Data from intervention studies on other treatment modalities were too limited to draw conclusions on the effects of these modalities on QoL. Interestingly, higher BMI and greater degree of depression showed consistently negative associations with QoL. Hypopituitarism was not significantly correlated with QoL in acromegaly. At present, there is insufficient published data to support that biochemical control, or treatment of acromegaly in general, is associated with improved QoL. Studies with somatostatin receptor ligand treatment, i.e., particularly lanreotide autogel and pegvisomant have shown improved QoL, but consensus on the correlation with biochemical control is missing. Longitudinal studies investigating predictors in treatment-naive patients and their follow-up after therapeutic interventions are lacking but are urgently needed. Other factors, i.e., depression and obesity were identified from cross-sectional cohort studies as consistent factors associated with poor QoL. Perhaps treatment strategies of acromegaly patients should not only focus on normalizing biochemical markers but emphasize improvement of QoL by alternative interventions such as psychosocial or weight lowering interventions.
Highlights
The World Health Organization recognizes three patient-related health outcome goals in chronic disease management: reducing mortality, reducing morbidity, and improving quality of life (QoL) (1)
The 88 remaining studies were checked for the aforementioned inclusion criteria; 15 of these studies were excluded on the basis of no description of predictors of QoL, and another 9 studies because the patients had been diagnosed with growth hormone deficiency (GHD) after treatment for acromegaly
In heterogeneous cohorts with both active and controlled disease, general factors that had a negative effect on QoL in patients with acromegaly were higher depression scores (21, 23, 31, 38, 42, 43) and higher BMI (10, 41)
Summary
The World Health Organization recognizes three patient-related health outcome goals in chronic disease management: reducing mortality, reducing morbidity, and improving quality of life (QoL) (1). QoL remains a major concern, since it often remains reduced despite long-term biochemical cure (6) In both patients with active or controlled acromegaly, QoL has been reported to be markedly decreased relative to the normal population, with some improvement after treatment. Usually cross-sectional designed because of the rarity of the disease, have been exploring disease-related and general factors (e.g., age, gender) that can affect QoL of patients with acromegaly. These studies included rather heterogeneous groups of patients with acromegaly (in terms of disease stages, extent of disease control, and treatment history) (7, 8). The contributions of multifactorial determinants of QoL in several disease stages are presently not well known
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