Assessment of depression, anxiety, quality of life and coping in long-standing multiple endocrine neoplasia type 2 patients.
Thyroid. 2017 Mar 09;:
Authors: Rodrigues KC, Toledo RA, Coutinho FL, Nunes AB, Maciel RM, Hoff AO, Tavares MC, Toledo SP, Lourenço DM
BACKGROUND: Scarce data on psychological harm in multiple endocrine neoplasia type 2 (MEN2) are available.
OBJECTIVES: To assess anxiety, depression, quality of life and coping in long-standing MEN2 patients.
PATIENTS AND METHODS: Forty-three adults (age ≥ 18 y) with clinical and genetic diagnosis of MEN2 and long-term follow-up (10.6±8.2 years; 1-33). A cross-sectional study with qualitative and quantitative psychological assessment using semi-directed interviews and HADS, EORTC QLQ C30 and MINI-MAC scales. Adopting clinical criteria from 2015 ATA Guidelines on MEN2, biochemical cure (39%, 16/41), persistence/recurrence (61%, 25/41), and stable chronic disease (22/41) of medullary thyroid carcinoma (MTC) were scored. Pheochromocytoma affected 19 patients (44%) with previous adrenalectomy in 17 of them.
RESULTS: Overall, anxiety (42%, mean score 11±2.9, range: 8-18; anxiety is defined as a score ≥ 8) and depression (26%, 11±3.8, 8-20; depression is defined as a score ≥ 8) symptoms were frequent. Patients who transmitted RET mutations to a child had higher scores of weakness-discouragement/anxious preoccupation and with lower scores of cognitive, emotional and physical functioning (p<0.05). Feeling of guilt was present in 35% of patients with mutation-positive children. Lower mean score values of depression and anxiety, higher scores of role, cognitive and emotional functioning were noticed in 33 patients well-informed about their disease (p<0.05). Fighting spirit was more frequently found in patients with multiple surgical procedures (p=0.019) and controlled chronic adrenal insufficiency (p=0.024). Patients with MEN2-related stress-inducing factors had lower scores of fighting spirit and cognitive functioning and higher scores of insomnia and dyspnea (p<0.05). Eleven patients required sustained psychotherapeutic treatment. Mean global health status was relatively good in MEN2 cases (68.1±22.3) and the cured group had higher physical functioning (p= 0.021).
CONCLUSIONS: Psychological distress is likely chronic in MEN2 patients. We identified diverse MEN2-related factors (degree of information on disease, mutation-positive children, number of surgeries, comorbidities, stress-inducing factors, cure) interfering positively or negatively with results of the psychometrics scales. The active investigation of these factors and the applied psychological assessment protocol are useful to identify MEN2 patients requiring psychological assistance.
PMID: 28276947 [PubMed - as supplied by publisher]