C. Marin1, L. Cybulski1, Z. Lewin3, J.B. Liu4, J. Moalem1,2, A.L. Moore1,2 1University Of Rochester, Department Of Surgery, Rochester, NY, USA 2University Of Rochester, Division Of Endocrine Surgery, Department Of Surgery, Rochester, NY, USA 3University Of Rochester, School Of Medicine And Dentistry, Rochester, NY, USA 4Brigham And Women’s Hospital, Division Of Endocrine Surgery, Department Of Surgery, Boston, MA, USA
Introduction: Many patients with primary hyperparathyroidism (PHPT) experience debilitating neuro-cognitive/-psychiatric symptoms (NCPS). While parathyroidectomy is the only cure for PHPT, PHPT-management guidelines do not include NCPS burden alone as an indication for surgery. This is likely because there is currently no standardized measurement of NCPS in PHPT. A potential solution to this problem is to use patient-reported outcome measures (PROMs) to measure NCPS. Although several PROMs have been studied in PHPT, they are not routinely utilized due to difficulty with data collection and uncertainty about which PROM would provide a meaningful clinical impact. We hypothesize that the PROMIS-29+2 Profile (PROPr) is an optimal PHPT-PROM, as it is high-quality, comprehensive of NCPS, integrated into many electronic medical record platforms, and is easy to administer. In this study, we also hypothesize that the PROPr will be noninferior to the Parathyroid Assessment of Symptoms (PAS, a validated, parathyroid-specific PROM).
Methods: We created an IRB-approved voluntary survey that included both the PROPr and the PAS. Surveys were distributed to patients aged ≥18 years with PHPT scheduled for parathyroidectomy at two timepoints: prior to surgery (baseline) and 2 weeks (2wk) post-operatively (post-op). Data were analyzed using R software.
Results: A total of 71 patients completed the PROPr assessment at baseline and 2wk post-op, and 56 completed the PAS as well (target n=68 and 14 respectively). At 2wk post-op, both PROPr (p=0.027) and PAS (p=0.025) scores significantly improved from baseline, and there was a moderate correlation between PROPr and PAS score improvement (r=-0.55, p<0.001). There was a weak but significant correlation between improvement in serum calcium levels and PROPr scores when comparing 2wk post-op from baseline (r=-0.255, p=0.045). A similar analysis for serum calcium and PAS scores showed a slightly stronger correlation (r=0.464, p<0.001).
Conclusion: Post-op PROPr scores significantly improved from baseline and were correlated with PAS score improvement, suggesting that PROPr captures NCPS burden in patients with PHPT and is noninferior to the PAS. Furthermore, post-op improvement in both PROPr and PAS scores correlated with improvement in serum calcium levels at 2wk post-op compared to baseline, suggesting that the degree of NCPS burden has a biological correlate. Taken together, our preliminary results support that the PROPr may serve as a new tool to measure NCPS in patients with PHPT. In the future, we aim to evaluate the longevity of these results, and the ease of PROPr implementation.