Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme

Abstract

PurposeHealth-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL.MethodsWe analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients’ baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage.ResultsA total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6 % women; 80.7 % papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9 % women; 76.3 % papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample.ConclusionOur results show that the favourable prognosis of DTC does not directly translate into good HRQOL in these patients. Persistent restrictions in regaining their normal daily life in terms of work and leisure highlight the importance of more detailed investigation of DTC patients’ wellbeing, support needs, and disease experience.

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

“…HRQoL was higher at the one-year follow-up, which was expected due to the timing of the first questionnaire. Similar results, with an increasing HRQoL during the first year have been demonstrated in previous studies 47,171 . The higher HRQoL after one year was probably related to a real improvement, but could be affected by a response shift.…”

“…A few studies assess HRQoL longitudinally. Although HRQoL increases over time, it does not reach the same levels as a general population 171 . During the first years of follow-up, HRQoL seems to fluctuate and starts increasing after five years 178 .…”

“…Several studies focus on HRQoL in thyroid cancer survivors during follow-up. The majority of the studies demonstrate lower HRQoL in thyroid cancer survivors compared with a general population [171][172][173][174] , although two studies show no significant differences 175,176 . Examples of domains with lower scores compared with the general population are physical, role, emotional, cognitive and social functioning 173 .…”

Age‐related differences in health‐related quality of life among thyroid cancer survivors compared with a normative sample: Results from the PROFILES Registry

“…A cancer diagnosis may have profound effects on the lives of adolescents and young adults, interfering with the attainment of normal developmental milestones. [6][7][8][9] A systematic review on HR-QOL among thyroid cancer survivors showed mixed results; thyroid cancer survivors, in general, have either a similar or a worse HR-QOL compared with the normative sample, and survivors reported specific medical problems that were associated with poorer HR-QOL. 5 In general, the diagnosis, treatment, and long-term follow-up of thyroid cancer can result in a decreased HR-QOL and increase in disease-specific symptoms.…”

“…5 In general, the diagnosis, treatment, and long-term follow-up of thyroid cancer can result in a decreased HR-QOL and increase in disease-specific symptoms. [6][7][8][9] A systematic review on HR-QOL among thyroid cancer survivors showed mixed results; thyroid cancer survivors, in general, have either a similar or a worse HR-QOL compared with the normative sample, and survivors reported specific medical problems that were associated with poorer HR-QOL. 6 However, little is known about age-related differences in HR-QOL.…”