Health-Related Quality of Life After Diagnosis and Treatment of Differentiated Thyroid Cancer and Association With Type of Surgical Treatment

Abstract

IMPORTANCE Concerns around possible overdiagnosis and overtreatment of differentiated thyroid cancer (DTC) have been raised. Issues concerning health-related quality of life (HRQOL) after diagnosis and treatment of DTC are understudied in this patient group. OBJECTIVE To better understand the range of HRQOL outcomes, including possible adverse effects of treatment, associated with diagnosis and treatment of DTC and whether these outcomes vary by type of surgery received. DESIGN, SETTING, AND PARTICIPANTS This content analysis assessed responses to anopen-ended question about outcomes and concerns after DTC diagnosis and treatment among patients ascertained from the major postsurgical thyroid cancer treatment center and the population-based Cancer Registry in Queensland, Australia. Participants were aged 18 to 79 years and recently diagnosed with throid cancer. Responses underwent analysis to identify and code emergent themes to describe HRQOL issues and adverse effects of treatment experienced. Quantitative analysis was used to explore whether surgery type was associated with HRQOL issues and/or adverse effects of treatment. Of 1416 eligible patients, 1005 (71.0%) participated. MAIN OUTCOMES AND MEASURES Issues concerning HRQOL. RESULTS The analysis included 1005 patients (72.2% female [n = 726]; mean [SD] age, 52 [14.0 years) with DTC. Most patients were diagnosed with papillary thyroid cancer (889 of 1003 [88.6%]), had tumors smaller than 2 cm in size (564 of 1000 [56.4%]), and received a total thyroidectomy (791 of 1005 [78.7%]). Overall, 775 patients (77.1%) reported HRQOL issues after diagnosis and treatment of DTC. The following 4 main themes emerged from content analysis of patient responses: physical (663 [66.0%]), psychological (187 [18.6%]), lifestyle (82 [8.2%]), and no issue or adverse effect (246 [24.5%]). Patients who had a total thyroidectomy (without neck dissection) were 1.5 times (odds ratio, 1.49; 95% CI, 1.04-2.12) more likely to report an HRQOL issue or an adverse effect of treatment compared with patients who underwent a hemithyroidectomy. CONCLUSIONS AND RELEVANCE According to results of this study, patients diagnosed with DTC report wide-ranging HRQOL issues; these are more prevalent among patients who have total thyroidectomies rather than hemithyroidectomies. For patients with small, localized DTCs, hemithyroidectomy may offer fewer adverse effects of treatment and better HRQOL outcomes than total thyroidectomy. It appears that issues with HRQOL should be considered by patients and physicians when deciding on the best treatment approach after a diagnosis of DTC.

Health-related quality of life analysis in differentiated thyroid carcinoma patients after thyroidectomy

“…Thyroidectomy is still the most commonly performed surgery for any type of thyroid carcinoma 20 . Surgical resection, radioactive iodine therapy, and long-term L-thyroxine replacement therapy can cause various problems in the daily life and psychological state of DTC patients 9 .…”

Contemporary Debates in Adult Papillary Thyroid Cancer Management

“…Diagnosis usually leads to cancer treatments, with potential complications from unnecessary surgery or radioiodine treatment. Thyroid cancer patients have been documented to have significant impairments in quality of life (18,19), which could be related to either or both of these factors. There may be considerable personal financial costs related to cancer therapy, even leading to bankruptcy (20).…”

“…It is reasonable to suggest that a second surgery in the rare patient with locoregional recurrence is preferable to subjecting all patients to what is likely unnecessary surgery in the majority. Furthermore, a recent population-based study found a higher rate of adverse quality of life issues and/or treatment related effects in patients who had undergone total thyroidectomy (excluding those who also had lateral neck dissections) compared with those who had undergone a lobectomy (OR, 1.49; 95%CI, 1.04-2.12) (19). A key question for clinicians and patients considering conservative surgery is what specific disease-related features should preclude lobectomy or lead to completion thyroidectomy, taking into account patient preferences and health system expertise.…”

What the thyroid cancer patient wants to know: ThyCa survey by the American Head and Neck Society Endocrine Surgery Section

“…1 Compared to age-and sex-matched controls, thyroid cancer survivors report worse quality of life (QOL), including clinically lower levels of psychosocial and physical functioning and significantly more physical and emotional symptoms. [2][3][4][5][6][7][8][9] Indeed, QOL in thyroid cancer is similar or lower to that of other cancers with worse survival. 8 Patients with thyroid cancer that experience severe financial crisis requiring bankruptcy face earlier mortality.…”