Cancer Care During COVID-19 Era: The Quality of Life of Patients With Thyroid Malignancies

Abstract

Background: The Covid-19 pandemic's potential psychological impact has been widely discussed on the basis of expert opinion and previous experience with emergencies of this type. We conducted a survey of cancer patients to explore more objectively the outbreak's impact on their emotional well-being and quality of life. Methods: Between March 18 and April 4, 2020, at an endocrine cancer center in Rome, Italy, 137 patients were asked to complete an online 6-item questionnaire developed by our staff to explore the emotional effects of the Covid-19 outbreak in Italy (Covid-19 Emotional Impact Survey, C-19EIS). For validation purposes, we also asked participants to complete an online version of the validated Italian translation of the EORTC QLQ-C30 questionnaire. Responses were analyzed in relation to responders' age, sex, and clinical status (advanced/metastatic disease undergoing systemic treatment vs. stable metastatic thyroid cancer in active surveillance vs. low-risk thyroid cancers with no evidence of structural disease during standard follow-up). Results: Response rates were high (51% for the C-19EIS, 44.5% for the EORTC QLQ-C30). Overall C-19EIS scores indicated high concern over the outbreak (median 8/12). Scores were higher in women (8 [IQR 5–9] vs. 6 [IQR 5–8] in men; p = 0.048) and in patients <65 years (8 [IQR 5–9] vs. 6 [IQR 4–8] in older patients; p = 0.013). No differences emerged across clinical status groups. C-19EIS scores were inversely correlated with the EORTC QLQ-C30 Emotional function subscale (rho −0.69; p < 0.001). Conclusions: There is objective evidence that the Covid-19 outbreak is causing substantial emotional distress among cancer patients, regardless of their disease severity or current health-care needs.

Impact of COVID-19 on the thyroid gland: an update

“…ACE2 and TMPRSS2 expression levels are high in thyroid and more than in lungs [50] Abnormal immune responses and cytokine storm associated to COVID-19 may induce thyroid gland inflammation [50,54] Two mechanisms (i.e. indirect and direct) might account for the changes in the thyroid gland and HPT axis [9][10][11][12][13] COVID-19-related thyroid disorders could include thyrotoxicosis, hypothyroidism, nonthyroidal illness syndrome COVID-19-related SAT is generally comparable to classical SAT and it can occur after or during COVID-19 [36] Thyrotoxicosis in absence of neck pain is frequent in patients hospitalized for COVID-19 [42] Low TSH and T3 and thyrotoxicosis appear to be predictors of poor outcome of patients hospitalized for COVID-19 [7] Treatment plans for thyroid cancer are considerably changing in the direction of more teleconsultations and less diagnostic and therapeutical procedures [70][71][72][73][74][75] Further research is necessary to explore the impact of the limitation of scheduled clinical activities on outcomes of thyroid cancer patients and whether thyroid cancer (or treatment-specific factors) increase vulnerability to COVID-19…”

“…Moreover, during the COVID-19 pandemic, conventional strategies of care for thyroid nodule and cancer has been upset by the transmission risk of SARS-CoV-2 associated with in-person visits and diagnostic and therapeutical procedures. Some research teams have published their personal experiences on this topic to date [70][71][72][73][74][75]85]. Differences in results and management of care likely reflect differences in local SARS-CoV-2 transmission rates and the ability of the health systems to manage.…”

“…One main issue was investigated by Falcone et al [72] who analyzed the outbreak's impact on emotional well-being and quality of life of patients with thyroid cancer. They found [72] that the Covid-19 pandemic is causing substantial emotional distress among thyroid cancer patients, regardless of their disease severity or current health-care needs. In addition, high scores of psychological distress were found among women and in patients < 65 years [72].…”

“…They found [72] that the Covid-19 pandemic is causing substantial emotional distress among thyroid cancer patients, regardless of their disease severity or current health-care needs. In addition, high scores of psychological distress were found among women and in patients < 65 years [72].…”

Health-Related Quality of Life and Experiences of Sarcoma Patients during the COVID-19 Pandemic

“…Romito et al evaluated psychological distress in lymphoma patients and found anxiety and depressive symptoms in around one-third of patients during the pandemic [40]. Using a self-developed COVID-19 questionnaire, Falcone et al found mean COVID-19 concern of 8/12 (interquartile range {IQR} 5-9) in thyroid cancer patients, which was inversely correlated with EORTC-QLQ-C30 emotional functioning scores [41]. Although these studies used a variety of questionnaires (validated or developed by researchers) and included patients with heterogeneous socio-demographic characteristics, different cancer types and disease stages, they further highlight the unmet need for psychological support in cancer patients during the COVID-19 pandemic and across the disease trajectory [42].…”