Tumor/Treatment-Related Hypothalamic Obesity Requires Multidisciplinary Care Strategies: A German Claims Data Analysis

OBJECTIVES: Survivors of sellar/suprasellar tumors involving hypothalamic structures face a risk of significant comorbidities impairing health and quality of life. Following the index removal of the tumor, patients present with a complex clinical profile, including hypothalamic obesity (HO), defined as abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment related damage of the hypothalamus. This study analyzes claims from a German payer database to better understand the follow-up and therapies required for patients living with tumor/treatment-related HO (TTR-HO) during the two years following the index surgical treatment.

METHODS: A database algorithm was used to identify patients with TTR-HO in a representative German payer claims database (n=5.24 million patients) covering the years 2010-2021. Claims from 37 patients with TTR-HO were analyzed on a quarterly basis over a 2-year period. The analysis considered inpatient stays and outpatient visits, and detailed prescription therapies were analyzed and longitudinal analyses as well as age group comparisons were performed.

RESULTS: Patients with TTR-HO are hospitalized on average 3.68 times in the 2-year follow-up period; 37% of hospitalizations in the first year and 31% in the second year are due to TTR-HO. During this period, on average, patients see a general practitioner 12.27 times and specialists 20.45 times, with visits to multiple specialists. Management of central diabetes insipidus and hypopituitarism begins early, in the index and first quarter, respectively. The need for complex hormone polytherapy develops quickly following the index event, and most patients have neuroendocrine polytherapy of 2-3 prescriptions in any given quarter.

CONCLUSIONS: The management of patients with TTR-HO is complex, including multiple inpatient visits for tumor follow-up and management of incident comorbidities. Most patients with TTR-HO receive complex polytherapy. These findings underscore the need for multidisciplinary care strategies (or holistic approaches) and tailored treatment plans to improve TTR-HO patients’ outcomes.