BACKGROUND: For a comprehensive assessment of the effect of surgery in patients with primary hyperparathyroidism (PHPT), as well as for monitoring the condition of patients after treatment, it sounds reasonable to evaluate quality of life (QoL) and symptoms in PHPT patients before and after surgery.AIM: The aim of this study was to assess changes in the QoL and symptoms in patients with PHPT after surgery.MATERIALS AND METHODS: During prospective observational study, patients filled out QoL questionnaires and evaluated the presence and severity of their symptoms prior to parathyroidectomy (PTE) and 3, 12 months after surgery. Statistical analysis included the following methods: Student’s t-test or Wilcoxon’s non-parametric test, the generalized estimating equations (GEE), correlation analysis, χ2 and McNemar tests.RESULTS: The study included 72 patients (mean age 52 years, 97.2% female) with symptomatic (68.1%) and asymptomatic (31.9%) PHPT. Before surgery patients with PHPT exhibited significantly decreased role functioning, physical and social well-being, and vitality. Half of PHPT patients experienced moderate-to-severe symptoms such as weakness, fatigue, loss of concentration, mood changes, as well as joint and bone pain; the association between symptoms experienced and the extent of QoL impairment before surgery was shown. Three months after PTE improvement in both physical and psychological components of QoL was shown. Positive QoL changes were demonstrated in patients with both symptomatic and asymptomatic PHPT and they preserved for 12 months after surgery. Also within 12 months after PTE significant decrease in PHPT-associated symptoms such as weakness, fatigue, loss of concentration and mood changes was found.CONCLUSION: The results obtained demonstrate efficacy of PTE from the patient’s perspective and confirm the value of QoL assessment in PHPT patients in management of this patients’ population both for decision making and for evaluation of benefits of surgery and the degree of recovery of patients at long term follow-up.
Purpose. Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by a parathyroid tumor or hyperplasia, which is often accompanied with quality of life (QoL) impairment. A parathyroidectomy (PTХ) is the preferred standard treatment for PHPT patients. In this single center study we аimed to evaluate the impact of PHPT оn patient’s QoL and identify QoL changes at early and long-term follow-up after surgery. Methods. All the patients underwent routine PTХ with the removal of the suspected hyperparathyroid gland(s). Patients filled out generic QoL questionnaire RAND SF-36, specific questionnaire PHPQoL and specific symptom assessment questionnaire PAS upon admission to the hospital before surgery, at 3 months, 12 months and 24 months after surgery. Results. A total of 92 patients with PHPT (median age was 56 years, 95.7% females) were included in the study. Before PTХ patient’s QoL was significantly lower as compared to healthy controls (p < 0.01). Almost 40% of patients had poor or very poor QoL. After surgery there was significant improvement in QoL by all scales of SF-36 questionnaire, excluding bodily pain, and the PHPQoL total score (GEE, p < 0.01) as compared with their values before surgery. Decreased mental component of QoL by PHPQoL (OR = 0.927, 95%CI = 0.874–0.984, p = 0.013) predicted improved QoL after surgery. Conclusions. Patients with PHPT demonstrated significantly impaired QoL in physical, psychological and social functioning as well experienced a wide profile of common PHPT symptoms. Successful PTX was accompanied with remarkable QoL improvement and decrease in subjective symptoms for at least 24 months after surgery.
Обоснование Обоснование. Оценка качества жизни до и после хирургического лечения при первичном гиперпаратиреозе (ПГПТ) может быть использована для комплексной оценки эффекта терапии, а также мониторинга состояния больного после операции, в том числе в реальной клинической практике. Цель Цель. Целью исследования являлась валидация русской версии опросника PHPQoL для оценки качества жизни у больных первичным гиперпаратиреозом (ПГПТ) и его апробация в отечественной популяции больных ПГПТ с целью дальнейшего применения в клинической практике и научных исследованиях. Материалы и методы Материалы и методы. В соответствии с международными стандартами проведены процедура языковой и культурной адаптации опросника PHPQoL, а также тестирование в фокусной группе больных ПГПТ с последующей оценкой психометрических свойств инструмента — надежности, валидности и чувствительности. Результаты Результаты. В исследовании участвовали 65 больных ПГПТ (средний возраст — 52,3±10,5 года, 97% — женщины), из которых у 67,7% установлена манифестная форма заболевания, у 35,4% пациентов имелась умеренная или тяжелая форма гиперкальциемии. Все пациенты заполняли валидированную нами русскую версию опросника PHPQoL до паратиреоидэктомии. Треть пациентов заполнили опросник повторно через 3 мес после операции. В ходе апробации опросника продемонстрированы высокие показатели его внешней и содержательной валидности, а также показана устойчивая структура инструмента, свидетельствующая об удовлетворительной конструктной валидности опросника. Также показана способность опросника определять различия показателей симптомов/проблем ПГПТ между пациентами в зависимости от выраженности клинических признаков заболевания и в процессе лечения. Продемонстрирован положительный эффект хирургического лечения на качество жизни больных ПГПТ после операции. Заключение Заключение. Результаты, полученные в ходе исследования, свидетельствуют о надежности, валидности и чувствительности русской версии опросника PHPQoL и приемлемости его дальнейшего использования в научных исследованиях и клинической практике в отечественной эндокринологии.
Background Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by a parathyroid tumor or hyperplasia, which is often accompanied with quality of life (QoL) impairment. A parathyroidectomy (PTX) is the preferred standard treatment for PHPT patients. In this single center study we aimed to evaluate the impact of PHPT on patient’s QoL and identify QoL changes at early and long-term follow-up after surgery. Methods All the patients underwent routine PTX with the removal of the suspected hyperparathyroid gland(s). Patients filled out generic QoL questionnaire RAND SF-36, specific questionnaire PHPQoL and specific symptom assessment questionnaire PAS upon admission to the hospital before surgery, at 3 months, 12 months and 24 months after surgery. Results A total of 92 patients with PHPT (median age was 56 years, 95.7% females) were included in the study. Before PTX patient’s QoL by SF-36 scores was significantly lower as compared to healthy controls (p < 0.01). Almost 40% of patients had poor or very poor QoL. The most frequent symptoms by PAS before surgery were as follows: tiredness (97.8% of patients), weakness (94.6%), forgetfulness (94.6%), mood changes (90%), feeling “blue”/depression (88%), joint pains (83.3%), headaches (80.2%), constant irritability (77.2%), bone pains (75%), thirst (70.7%) and trouble getting out of a chair (67.4%). The half of the patients had moderate-to-severe (≥ 40 scores) tiredness, weakness, joint pains, forgetfulness, as well as mood changes. Post-operative QoL changes were analysed in the group of 72 patients. After surgery there was significant improvement in QoL by all scales of SF-36 questionnaire, excluding bodily pain, and the PHPQoL total score (GEE, p < 0.01) as compared with their values before surgery. Also severity of tiredness, mood changes, weakness and forgetfulness significantly decreased after surgery as compared to their baseline values (GEE, p < 0.05). Decreased mental component of QoL by PHPQoL (OR = 0.927, 95%CI = 0.874–0.984, p = 0.013) predicted improved QoL after surgery. Conclusions Patients with PHPT demonstrated significantly impaired QoL in physical, psychological and social functioning as well experienced a wide profile of common PHPT symptoms. Successful PTX was accompanied with remarkable QoL improvement and decrease in subjective symptoms for at least 24 months after surgery.
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