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Thyroid cancer quality of life improves with active surveillance
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Active surveillance of adults with papillary thyroid microcarcinoma may not only be a reasonable management option, but may also confer improved quality of life compared with lobectomy, according to findings published in Thyroid.
“As the risk of mortality or recurrence associated with [papillary thyroid microcarcinomas] is low, recent studies have proposed management by active surveillance as an alternative to immediate surgery in patients with low-risk [papillary thyroid microcarcinomas],” Won Bae Kim, MD, PhD, of the department of internal medicine at Asan Medical Center of the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues wrote. “Although oncologic outcomes are the key consideration when assessing the efficacy of a new management approach, it is also important to consider any impact on health-related quality of life.”
Kim and colleagues conducted a cross-sectional study in which 191 adults with papillary thyroid microcarcinoma were recruited between June 2016 and October 2017. Of the total cohort, 148 received lobectomy (mean age, 51 years; 85% women) and 43 received active surveillance (mean age, 50.3 years; 67% women). All participants completed questionnaires that evaluated health-related quality of life, thyroid cancer-related quality of life and fear of disease progression. Higher scores on the latter two questionnaires indicated worse quality of life and more fear, while a higher score on the first questionnaire indicated a better quality of life.
Participants in the active surveillance group reported better health when considering role limitations due to physical health (P = .047), social functioning (P = .045) and role limitations due to emotional problems (P = .031) compared with those who underwent lobectomy, although only the difference in role limitations due to emotional problems maintained significance after multivariate analysis. Active surveillance participants also reported superior quality of life related to scar problems (P < .001) and neuromuscular (P = .02) and throat/mouth (P = .043) status related to papillary thyroid microcarcinoma compared with those in the lobectomy group, even when adjusting for age, sex and thyroid-stimulating hormone levels. The two groups had similar scores in terms of fear of disease progression, the researchers reported.
“Since the concept of active surveillance was first introduced in patients with [papillary thyroid microcarcinomas], many studies have demonstrated that this approach may provide safe and effective management of low-risk [papillary thyroid microcarcinomas], particularly in older patients,” the researchers wrote. “The current study suggests that active surveillance may also have advantages in terms of patient [health-related quality of life] and supports the role of active surveillance in patients with [papillary thyroid microcarcinoma].” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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