Failure to achieve disease control in XXXX : cause analysis by a registry-based survey.

@entity1 @entity2012 @entity442 @entity137
UNASSIGNED: Context: Disease control is a prime target in @entity2012 treatment. This should be achievable in the vast majority of @entity1 by available treatment options. For unknown reasons, however, a significant number of @entity1 do not achieve disease control. Objective: To investigate reasons for failure to achieve disease control in long-standing @entity2012 . Design and Methods: Survey based on the German @entity2012 Registry database (1755 @entity1 in 57 centres). Questionnaires were sent to 47 centres treating 178 @entity1 with elevated disease markers ( @entity442 , GH) at the last documented database visit out of 1528 @entity1 with a diagnosis dated back >=  2 years. Thirty-three centres returned anonymised information for 120 @entity1 (recall rate 67.4%). Results: Median age of the 120 @entity1 (58 females) was 57 years (range 17-84). Ninety-four @entity1 had at least one operation, 29 had received radiotherapy, and 71 were previously treated medically. Comorbidities were reported in 67 @entity1 . In 61 @entity1 disease activity had been controlled since the last documented database visit, while 59 @entity1 still had biochemically active disease. Reasons were @entity1   denial to escalate therapy (23.3%), non-compliance (20.6%), fluctuating @entity442 and GH levels with normal values at previous visits (23.3%), and modifications in pharmacotherapy (15.1%). Therapy resistance (9.6%), @entity137 (4.1%), and economic considerations (4.1%) were rare reasons. Conclusions: Main reasons for long-standing active @entity2012 were @entity1   lack of motivation to agree to therapeutic recommendations and non-compliance with medical therapy. Development of @entity1 education programmes could improve long-term control and thus prognosis of @entity2012 @entity1 .
