Anxiety and Fear of Recurrence Despite a Good Prognosis: An Interview Study with Differentiated Thyroid Cancer Patients

Hedman, Christel; Strang, Peter; Djärv, Therese; Widberg, Ida; Lundgren, Catharina Ihre

doi:10.1089/thy.2017.0346

Cited by 69 publications

(65 citation statements)

References 196 publications

(307 reference statements)

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“…The participants likely had the least anxiety because they were just assured that there was no progression or recurrence of their disease by medical examination. Second, patients' anxiety might also be explained by other factors such as variations in the ways that physicians provided explanations to the patients, as well as in the clinical management strategies, such as follow-up examinations during the postoperative observational period (31). Finally, the study was underpowered to detect a clinically meaningful difference in some of the effect sizes because of the limited number of patients under active surveillance who were available for the survey.…”

Section: Discussionmentioning

confidence: 99%

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Yoshida

Horiuchi

Okamoto

2020

Thyroid

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Background: Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions on the options have rarely been addressed. Methods: A cross-sectional survey was conducted on 50 patients with PTMC who were under either active surveillance (n = 20) or postoperative follow-up (n = 30). The primary outcome was anxiety, which was measured using the State-Trait Anxiety Inventory (STAI). A questionnaire that comprised six items about PTMCrelated symptoms and concerns, which were measured with a visual analog scale, was also administered. Cohen's d effect size was calculated to express group differences. Multiple regression analysis was used to examine the relationships between state anxiety and other variables. Results: The median age and observation period were 61.5 years (range, 40-83 years) and 4.1 years (range, 0-8.6 years), respectively. The female/male ratio was 38/12. Compared with the surgery group, the active surveillance group showed higher scores in both state anxiety and trait anxiety, with corresponding effect sizes of 0.55 (confidence interval [CI]-0.03 to 1.1; p = 0.068) and 0.63 (CI 0.02-1.2; p = 0.037), respectively. Trait anxiety (b = 0.83) and observation time (b =-1.57) were the significant predictors of state anxiety. Moderate effect sizes were observed for ''discomfort in the neck'' (-0.53; CI-1.11 to 0.04); ''weak voice'' (-0.46; CI-1.03 to 0.12); and ''nervous about neck appearance'' (-0.64; CI-1.23 to-0.07), in favor of active surveillance. Conclusions: State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management. Understanding the patients' view appears to be key to improve shared decision-making.

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Section: Discussionmentioning

confidence: 99%

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Yoshida

Horiuchi

Okamoto

2020

Thyroid

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“…The current position of lifelong follow-up with measurement of thyroglobulin leaves the patient without the prospect of ultimately being told they have been 'cured'. Recurrent hospital visits and the status of not being 'cured' leads to chronic anxiety and continued concern for the patient [13,14]. Much of this could be addressed by early implementation of a simple effective plan of follow-up after DRS with the patient that incorporated annual follow-up with measurement of thyroglobulin and thyroglobulin antibodies for 5 years, with an explanation that thereafter the risk of recurrence would be very low indeed (<0.3%).…”

Section: Discussionmentioning

confidence: 99%

Can We Discharge Dynamically Risk-Stratified Low-Risk (Excellent Response to Treatment) Thyroid Cancer Patients After 5 Years of Follow-Up?

et al. 2019

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Aims: The 2014 British Thyroid Association thyroid cancer guidelines recommend lifelong follow-up of thyroid cancer patients. This is probably unnecessary, can cause patient anxiety, is time consuming and places significant demand on National Health Service resources. It has been suggested that low-risk differentiated thyroid cancer (DTC) patients could be discharged to primary care once they are 5 years from diagnosis and treatment. The aim of this study was to investigate the potential safety of this practice. Materials and methods: In total, 756 patients with dynamically risk-stratified (DRS) low-risk/excellent response to treatment DTC treated over 2001e2013 in the Leeds region were followed after diagnostic surgery and the recurrence rate calculated. Results: The median follow-up time was nearly 10 years (5e17 years). Radiological recurrence occurred in 13/756 (1.7%) patients and was always preceded by raised thyroglobulin/ thyroglobulin antibody levels. In all 13 patients elevation of thyroglobulin occurred within 5 years of diagnosis. Two additional patients were found to have rising thyroglobulin at almost 9 and 10.5 years from diagnosis, although to date radiological recurrence has not been detected. Assuming these two patients developed recurrence with longer duration of follow-up, then 0.26% (2/756) of patients would not have their recurrence discovered within 5 years of diagnosis. To detect 100% of patients with a putative recurrence in our cohort would require 10.5 years of follow-up. Four patients had transiently raised thyroglobulin, which became undetectable within 2 years (in three patients), without any treatment and radiological recurrence was not discovered. Conclusion: Discharge of DRS low-risk DTC patients to primary care after 5 years of secondary care follow-up is reasonable, accepting that late recurrence may occur in a very small minority of individuals (0.26%, w1:400). A more cautious approach would be to continue monitoring for 10 years, although the frequency of assessments could be reduced with increasing duration of follow-up.

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“…Anxiety is known to be common among cancer patients, both in those cured of their disease as well as in those with metastatic involvement (22,121). Although, from a doctor's point of view, DTC is a cancer with excellent prognosis, anxiety and fear of tumour recurrence or disease progression are an important finding in psychological interviews of patients with DTC (122,123). Almost half of the DTC patients with an excellent prognosis will still worry about recurrence even 15 years after diagnosis (124).…”

Section: Psychological Considerationsmentioning

confidence: 99%

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Lamartina

Handkiewicz-Junak

2020

European Journal of Endocrinology

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Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

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Anxiety and Fear of Recurrence Despite a Good Prognosis: An Interview Study with Differentiated Thyroid Cancer Patients

Abstract: Anxiety is a common, although partially hidden, problem in DTC survivors, as they tended to deny it early in the dialogues. As anxiety is clearly related to follow-up routines, these should therefore be revaluated.

Cited by 69 publications

References 196 publications

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Can We Discharge Dynamically Risk-Stratified Low-Risk (Excellent Response to Treatment) Thyroid Cancer Patients After 5 Years of Follow-Up?

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

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