Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: A study from the population-based PROFILES registry

Abstract

Background. Given the longevity of thyroid cancer patients, any impairment in health-related quality of life (HRQoL) during the follow-up period is of considerable concern. Therefore, the fi rst aim of this study was to assess (thyroid cancer specifi c) HRQoL among long-term thyroid cancer survivors and to compare this with the HRQoL of an age-and sex-matched normative population. Secondly, our aim was to investigate which clinical and socio-demographic characteristics and thyroid cancer specifi c problems were associated with HRQoL. Material and methods. All patients diagnosed with thyroid cancer between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a survey on HRQoL (EORTC QLQ-C30) and disease-specifi c symptoms (THYCA-QoL). The scores were compared with age-and sex-matched cancer free controls (n ϭ 800). A series of multiple linear regression analyses were conducted to investigate the independent associations between clinical, socio-demographic and thyroid cancer specifi c factors with HRQoL. Results. A total of 306 patients (86%) responded to the invitation. Thyroid cancer survivors had signifi cantly lower scores on physical, role, emotional, cognitive and social functioning (p Ͻ 0.001) compared to the normative population after adjusting for comorbidities. Sympathetic problems [feeling chilly (52%), hot fl ushes (40%)], neuromuscular problems [cramp legs (43%) and pain joints/muscles (64%)] and abrupt attacks of fatigue (50%) were the most often reported thyroid cancer specifi c complaints. Thyroid cancer specifi c neuromuscular, concentration, sympathetic and psychological problems explained 41-58% of the variance in HRQoL. Clinical and socio-demographic factors explained a small part of the variance in (thyroid cancer specifi c) HRQoL (1-27%). Conclusion. Long-term thyroid cancer survivors experience more symptoms and deteriorated HRQoL compared to the normative population. Thyroid cancer specifi c neuromuscular, sympathetic, concentration and psychological symptoms are stronger associated with HRQoL than clinical and socio-demographic factors alone. Awareness of these specifi c determinants of HRQoL could help health care practitioners to provide better supportive care.

Determinants of long-term quality of life in patients with differentiated thyroid carcinoma – a population-based cohort study in Sweden

“…a group with a good or even excellent prognosis but with a lifelong risk of recurrence. In line with previous research, our patients reported poorer HRQoL than the general population, which might be due to the lifelong thyroid hormone treatment and diffuse symptoms, such as muscle ache, fatigue, difficulties coping with heat, and palpitations influencing daily life [8].…”

“…We also included a studyspecific questionnaire with relevant questions based on the literature [2]. Recently, a validated thyroid cancer-specific questionnaire, not available at the time of our data collection, was published [8,25] which could also have been of interest.…”

“…In general, long-term HRQoL after DTC has been shown to be both similar to and decreased in comparison with the general population [8][9][10][11] but determinants of HRQoL have been sparsely described.…”

Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study

“…Most studies on thyroid cancer survivorship in North America have reported a modest decrease in quality of life (QoL) after treatment (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, careful review of these data shows that the study populations were small, the tools were inconsistent and not tailored for thyroid cancer survivors, the sampling techniques did not take into account the varied survivor populations found in modern society, and only five small studies were conducted in the United States (12,14,16,18,19).…”

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

“…This is particularly important, since thyroid surgery can result in clinically significant morbidity (alterations in voice associated with damage to recurrent and superior laryngeal nerves, hypoparathyroidism, and rarely airway obstruction associated with bilateral vocal cord dysfunction, hematoma formation, or infection), particularly when the surgery is performed by low-volume surgeons (7,8). Furthermore, after total thyroidectomy, many patients have persistent fatigue (9), weight gain (10), and cognitive complaints (11), even when optimized on thyroid hormone therapy. In light of the very low disease-specific mortality associated with PMCs, the lack of proven benefit of thyroid surgery, and the potential for side effects and complications from thyroidectomy, there is an obligation to consider alternative management strategies carefully.…”