Endocrine Abstracts

Unwanted late effects of cranial irradiation frequently include endocrine and psychosocial impairment, which may be overlooked in routine follow-up. The aim of the present study was to obtain systematic data on the long-term, psychosocial impairments of patients treated with cranial irradiation as compared to a non-irradiated control group. Both groups were fully hormone replaced including growth hormone (GH) substitution.

A compilation of questionnaires assessing quality of life, depression, psychological distress and ability to work was mailed to all patients treated in a specialized single centre late-effects clinic. Patients included had received cranial irradiation at least 36 months ago and were on stable hormone replacement including GH (Ethical approval obtained). A group of similarly replaced but non-irradiated patients served as controls.

QoL was assessed using the QoL-AGHDA and SF-36 questionnaire. The BDI-II was used to evaluate depression. Sleep disturbances and daytime sleepiness were assessed by the PQ7I and the ESS, respectively. The WPAI-GH was used to assess capability and impairment at work.

Of 54/197 questionnaires from the irradiated group were returned and analyzed. QoL in the QoL-AGHDA was severely diminished in 51% of the patients and 40% showed depressive symptomatology in the BDI-II. Impaired mental QoL in the SF-36 was evident in 22%. Sleep disturbances and daytime sleepiness were prominent with 72% exhibiting scores of significant sleep disturbance in the PQ7I and 35.2% qualifying for specialist sleep advice according to the ESS. 35 questionnaires from non-irradiated patients analysed for comparison confirmed more severe forms of sleep disturbance including daytime sleepiness but differences between did not reach significance.

Expectedly, both brain-irradiated and non-irradiated patients suffer from a high degree of psychosocial impairment, including reduced QoL and depression. The dominant sleep disturbances observed were surprising and warrant intensive screening in this group of patients.