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Reduced quality of life, fear of recurrence remain in adults with DTC
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Self-reported health-related quality of life is negatively affected by a diagnosis of differentiated thyroid cancer, or DTC, but outlook does improve within a year, according to findings published in Thyroid.
Christel Hedman, MD , PhD, of the department of molecular medicine and surgery at Karolinska Institutet, Sweden, and colleagues examined data from 235 Swedish-speaking adults (70% women) who were treated for thyroid cancer (80% papillary thyroid cancer; 234 with total thyroidectomy; one with hemi thyroidectomy) from 2012 to March 2017. Participants were followed for 1 year during the population-based, nationwide, prospective study, with assessments made for health-related quality of life (HRQoL) and fear of recurrence both at diagnosis and 1 year after.
The researchers used the Swedish version of the SF-36 to assess quality of life. To determine fear of recurrence, participants were asked whether their condition affected their view of life and how often they were concerned with recurrence.
At the 1-year follow-up, 40 participants reported a negative view of life vs. 50 at diagnosis. A negative view both at diagnosis and a year later was reported by 18 participants. Compared with patients reporting a positive view or no change in view with diagnosis, those reporting a negative view at diagnosis (P < .001 to .036) and those reporting a negative view at the 1-year mark (P < .001 to .01) also had reduced quality of life.
As for recurrence, 31% of the participants said they were fearful “often” while 44% said they seldom felt that way. There was an 8% drop in the number of participants who reported frequent fear of recurrence after a year, whereas 46% seldom experienced such fear.
“Fear of recurrence affects patients with all forms of cancer and is surprisingly prevalent in DTC patients, despite the longevity in patients with this disease,” the researchers wrote. “DTC has been considered to be a ‘good cancer,’ which, however, is not necessarily in congruence with patients’ own perceptions. This might make the coping process more complicated and add to the fear of a recurrence. In addition, depression has been shown to be prevalent in DTC compared to other cancers.”
Researchers also considered thyroid-stimulating hormone levels. After a year, 79% of participants (n = 171) had moderate or complete TSH suppression (TSH < 0.1 mIU/L). The 9% who had mild suppression (0.1 to < 0.4 mIU/L) reported worse quality of life compared with those with moderate or total suppression, which the researchers said agreed with previous data even if suppression did not significantly improve quality of life.
On bivariate analyses, the researchers found that older age, living alone, lower education, fear of recurrence, negative life views and comorbidities were linked to lower levels of reported quality of life (P < .05). On multivariate analyses, reduced HRQoL at baseline predicted the same at 1-year follow-up (P < .05).
“As fear of recurrence and a negative view of life substantially affect HRQoL, DTC patients should be given additional attention in order to improve their HRQoL,” the researchers wrote. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopThis study illustrates that despite having a good prognosis, a significant number of patients with differentiated thyroid cancer have decreased health-related quality of life at diagnosis with some improvement a year later. Fear of recurrence and a negative view of life at diagnosis had a negative correlation with quality of life at the 1-year follow-up. As thyroid cancer is curable in the majority of patients, it is perplexing why these patients exhibit fears similar to those with other malignancies, which have poorer prognosis.
On the flip side, one may expect thyroid cancer patients to exhibit anxiety and worry at diagnosis or soon thereafter, which would in turn impact quality of life. This could be justified as they are faced with decisions regarding treatment options, with potential for complications. In addition to fears about physical consequences of thyroid cancer treatment, patients may worry about financial consequences as well as the impact of their diagnosis on their social activities, family and work.
However, it is not known how these patients’ fears, perceptions and quality of life transform over the survivorship continuum, especially if they remain disease-free. More research is needed to explore thyroid cancer related worry and how it impacts quality of life long term, in order to develop effective preventative and management strategies for those at risk.
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