Psychosocial burden in adrenocortical carcinoma patients

Distress, fear of progression (FOP), and depression are common in cancer patients and negatively impact patients' health-related quality of life (HRQOL). However, no studies have explored these aspects in adrenocortical carcinoma (ACC), yet.

We conducted a single-centre observational study in adults (≥18 years) with ACC. We analysed questionnaires addressing FOP, distress (National Comprehensive Cancer Network distress thermometer), depression (patient health questionnaire, PHQ-9), and HRQOL (EORTC-QLQ-C30). Potentially influencing factors were evaluated. Multiple linear regression on HRQOL subscales was performed to identify associated psychosomatic correlations.

Within 12 months, 105 patients were included (56.2% female; median age 49 years, 14.3% newly diagnosed, 46.7% tumour-free, 39.0% metastatic). The majority experienced an elevated level of distress (62%) and of FOP (59%). PHQ-9 results suggested major depression in 41%. Of note, these results were neither influenced significantly by tumour burden, hormone excess nor by cancer treatment. Patients reported moderate functioning scores (median 62.2) and moderate symptom burden (median 33.3) in the EORTC-QLQ-C30. Fatigue and insomnia were prominent symptoms. Tumour burden and treatment affected functioning and symptoms, with significant differences in appetite loss, diarrhoea, nausea, vomiting, and financial difficulties. Hormone excess showed no significant impact on these measures. Our questionnaires indicated a need for psychosomatic counselling in 80% of patients.

Patients with ACC show high values for distress, FOP, and depression, which can only partly be explained by clinical characteristics. Our study suggests that psychosomatic support should be offered to all patients with ACC.