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More studies urged in managing posttreatment fatigue in thyroid cancer
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A paucity of reliable trials exists to guide evidence-based management of post-treatment fatigue in thyroid cancer survivors, according to a systematic review published in Thyroid.
“Some thyroid cancer survivors experience persistent post-treatment fatigue,” Anna M. Sawka, MD, PhD, of the division of endocrinology at the University of Waterloo, Ontario, Canada, told Endocrine Today. “Upon systematically reviewing the literature, we found relatively few randomized controlled trials examining how to treat fatigue in this population.”
Sawka, with Joshua To, a BSc candidate at the institution, and colleagues searched 1,086 unique citations and 25 full-text studies through electronic and hand searches; studies on short-term interventions used in preparation for radioactive iodine diagnostic scans or treatment were excluded.
The investigators selected four studies summarizing the results of three randomized controlled trials, with durations ranging from 10 weeks to 6 months.
The interventions included combination triiodothyronine with levothyroxine therapy vs. levothyroxine alone; reduction in degree of thyroid-stimulating hormone suppression using levothyroxine vs. maintenance of TSH suppression; and supervised exercise vs. inactivity.
“All of these trials had some limitations in their methods or reporting, including relatively small sample sizes,” Sawka said.
The number of thyroid cancer survivors participating in the randomized controlled trials ranged from 15 to 36. In trials involving hormonal treatment, mixed fatigue outcome results were observed. However, multiple measures suggested improvement in fatigue after the exercise intervention.
“More research is needed to understand the nature, causes, natural history, modifying factors and life impact of persistent post-treatment fatigue in affected thyroid cancer patients and survivors,” Sawka said. “Furthermore, more randomized controlled trials are needed to guide effective clinical management of fatigue in thyroid cancer patients and survivors.” — by Allegra Tiver
For more information:
Anna M. Sawka, MD, PhD, can be reached at Toronto General Hospital, 200 Elizabeth Street, 12 EN-212, Toronto, Ontario, Canada M5G 2C4; email: sawkaam@yahoo.com.
Disclosure: This work was funded in part by a University of Toronto Department of Medicine Strategic Innovation Fund Grant. One researcher had a summer co-op research internship funded by the University Health Network Cancer Survivorship Program, and another holds a Chair in Health Services Research from Cancer Care Ontario, funded by the Ontario Ministry of Health and Long-term Care.
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