Quality of Life in Patients with Low-Risk Papillary Thyroid Microcarcinoma: Active Surveillance Versus Immediate Surgery

Nakamura, Tomohiko; Miyauchi, Akira; Ito, Yasuhiro; M, Ito; Kudo, Takumi; Tanaka, Mika; Kohsaka, Kazuyoshi; Kasahara, Toshihiko; Nishihara, Eijun; Fukata, Shuji; Nishikawa, Mitsushige

doi:10.4158/ep-2020-0201

Cited by 36 publications

(37 citation statements)

References 33 publications

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“…However, triangulation does support additional stress beyond the underlying cancer diagnosis, suggesting at least some degree of increased psychosocial distress in the setting of the pandemic. Indeed, compared to literature values of patients with similar low-risk cancers, participants in this study had higher HADS and PSS scores [24][25][26].…”

Section: Discussioncontrasting

confidence: 45%

Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic

et al. 2021

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Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.

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Section: Discussioncontrasting

confidence: 45%

Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic

et al. 2021

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“…/eje.bioscientifica.com mPTC patients subjected to lobectomy (n = 148) reported more health-related problems compared to patients who decided not to operate (n = 43), even if the fear of progression was similar in the groups. Similar results were reported by Nakamura et al(61).…”

supporting

confidence: 92%

MANAGEMENT OF ENDOCRINE DISEASE: Papillary thyroid microcarcinoma: toward an active surveillance strategy

Molinaro

Campopiano

Elisei

2021

European Journal of Endocrinology

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In the last decades, the incidence of thyroid cancer (TC) has more than doubled, but the disease-specific mortality rate was stable. To date 30-40% of all TC is represented by papillary microcarcinomas (mPTC), an indolent tumor, that probably remained undiagnosed before routine ultrasound use. In 1993, Miyauchi was the first who hypothesized a conservative approach for low-risk mPTC and introduced the concept of active surveillance (AS) in its clinical management. The progression rate of mPTC during AS was low and delaying surgery did not impact on the efficacy of treatment or outcome. Since then, several authors from all over the world have reported their experience on AS in mPTCs. As suggested by current guidelines, AS can be considered as an alternative to immediate surgery to avoid over-treatment in low-risk mPTC and may be the strategy to avoid complications from unnecessary surgery. In the last years, the AS inclusion criteria have been extended to both bigger tumors and to younger/healthier patients. The adoption of AS should take into consideration not only tumor characteristics, but also patient psychological profiles and medical team expertise. Its safety and efficacy have been demonstrated in long-term outcome studies and in other types of tumors, however, scepticism in patients, families and physicians should be overcome by strong recommendations coming from scientific guidelines. This review analyses the several and different experiences on AS and the potential obstacles in implementing it as a routine approach in mPTC patients.

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“…In this review, we identified 20 studies reporting on physical HrQoL following TT or HT [ 18 , 34 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 67 , 68 , 70 , 73 ] ( Table 5 ). Eight studies compared postoperative TT HrQoL with community reference values using seven different QoL instruments (i.e., SF-36, MFI-20, ThyPRO, PSQI, Billewicz Score, visual analog scale, and 15D) [ 18 , 34 , 51 , 53 , 55 , 58 , 61 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies assessed postoperative physical-related HrQoL in comparison with patients undergoing active surveillance (AS) [ 54 , 60 , 67 ]. All three studies found a significant impairment in physical-related HrQoL for patients undergoing HT versus patients undergoing AS for at least one of the following items: global physical subscale ( n = 1), voice symptoms ( n = 1), trouble with concentration ( n = 2), neuromuscular symptoms ( n = 1), throat or mouth symptoms ( n = 2), feeling chilly ( n = 1), or problems with scar ( n = 2) [ 54 , 60 , 67 ]. For the two studies comparing postoperative TT HrQoL with AS, significant impairments were found in the surgery group for global physical subscale ( n = 1), weight gain ( n = 1), problems with scar ( n = 1), and vocal symptoms ( n = 1) [ 60 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, nine studies directly compared physical-related HrQoL for patients undergoing TT versus HT using six different questionnaires (EORTC-QLQ-C30, EORTC-QLQ-THY34, SF-36, THYCA-QoL, FoP-Q-SF, and KT-QoL) [ 52 , 56 , 57 , 59 , 60 , 62 , 64 , 65 , 67 ]. Four of these studies found decreased physical-related HrQoL following TT compared with HT for at least one of the following items: global physical subscale ( n = 1), voice symptoms ( n = 1), sensory symptoms ( n = 1), neuromuscular symptoms ( n = 1), vitality ( n = 1), and problems with scar ( n = 1) [ 57 , 59 , 64 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

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Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review

et al. 2022

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Health-related quality of life (HrQoL) is a major concern for patients with differentiated thyroid carcinoma (DTC). We aimed to systematically review the literature comparing HrQol following total thyroidectomy (TT) and hemithyroidectomy (HT) in DTC patients. A systematic review of publications indexed in Medline, Embase, and EBM reviews—Cochrane Central Register of Controlled Trials, which evaluated HrQoL following thyroid surgery for DTC, was conducted. Of 2507 identified records, 25 fulfilled the inclusion criteria. Our results suggest that patients undergoing TT may suffer more impairment in physical and social HrQoL than patients undergoing HT. Psychological-related HrQoL and long-term global HrQoL are, however, equivalent in both groups, which highlights the multidimensional nature of HrQoL and the importance of a multitude of factors aside from treatment modalities and related morbidities, such as the experience of receiving a cancer diagnosis, the fear of cancer recurrence, and other psychosocial factors. Addressing postoperative HrQoL when discussing therapeutic options with patients is an integral part of patient-centered care and informed shared decision-making, and should be approached in a holistic manner, accounting for its physical, psychological, and social aspects. This review supplies evidence regarding HrQoL following thyroid surgery, which can be employed in such decisions.

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Quality of Life in Patients with Low-Risk Papillary Thyroid Microcarcinoma: Active Surveillance Versus Immediate Surgery

Cited by 36 publications

References 33 publications

Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic

Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic

MANAGEMENT OF ENDOCRINE DISEASE: Papillary thyroid microcarcinoma: toward an active surveillance strategy

Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review

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