Adults experience less fear, worry after surgery for low-risk papillary thyroid cancer
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Key takeaways:
- Thyroid cancer-related fear and worry scores declined for adults 9 months after a thyroidectomy compared with before surgery.
- Scores were similar for adults who had a hemithyroidectomy vs. total thyroidectomy.
Adults with low-risk thyroid cancer who underwent surgery had significant reductions in cancer-related fear and worry after their procedure compared with before surgery, researchers reported.
For a study published in in The Journal of Clinical Endocrinology & Metabolism, researchers surveyed adults with confirmed or likely papillary thyroid cancer about their level of thyroid cancer-related fear and worry prior to undergoing a hemithyroidectomy or total thyroidectomy, and again 9 months following the procedure. Participants who had a hemithyroidectomy reported similar levels of worry and fear as those undergoing a total thyroidectomy. Adults in both groups reported declines in both cancer-related fear and worry at 9 months compared with before surgery.
“Clinically, our findings suggest that interventions are needed early in the diagnostic process to reduce patients’ negative emotional experience,” Susan C. Pitt, MD, MPHS, associate professor of surgery and director of engagement, Center for Healthcare Outcomes and Policy at the University of Michigan, told Healio. “These interventions may improve the overall psychosocial well-being and long-term outcomes of patients with thyroid cancer.”
The study included adults aged 18 years or older with thyroid nodules of 4 cm or less in diameter who did not have evidence of lymph node or distant metastasis and were planning to have thyroid surgery. Two 5-point Likert scale questionnaires were conducted to assess thyroid cancer-specific fear and worry. On the fear scale, a score of more than 23 points was considered a high level of fear, a score of 16 to 23 points was defined as medium fear and a score of 8 to 15 points was categorized as low level of fear. On the worry scale, a high level of worry was any score from 7 to 13 points, moderate worry was defined as a score of 5 to 6 points and low worry was considered a score of 3 to 4 points.
No difference between surgery types
There were 114 adults who completed the survey at baseline and at 9 months. Among those, 41 had a hemithyroidectomy performed and 73 underwent a total thyroidectomy.
At baseline, mean cancer-related fear scores were similar between those who had a hemithyroidectomy vs. total thyroidectomy (mean score, 25.1 points vs. 26.1 points; P = .42). The percentage of adults with a high level of cancer-related fear was similar between the hemithyroidectomy (58.5%) and total thyroidectomy groups (68.5%; P = .285).
Adults who underwent a hemithyroidectomy also reported a similar level of cancer-related worry at baseline as those who had a total thyroidectomy performed (mean score, 7.9 vs. 8.4, respectively; P = .34). The percentage of adults with a high level of worry was similar between those who underwent a hemithyroidectomy and those who had a total thyroidectomy (73.2% vs. 76.7%, respectively; P = .67).
Fear, worry decline after surgery
Mean cancer-related fear scores declined from 25.8 at baseline to 23.1 at 9 months, and cancer-related worry scores decreased from 8.2 at baseline to 5.4 at 9 months (P < .001). The decline in cancer-related fear and worry was observed among adults, regardless of the type of surgery they chose.
At follow-up, the scores were similar between the groups for cancer-related fear (hemithyroidectomy, 23.3; total thyroidectomy, 23; P = .85) and cancer-related worry (hemithyroidectomy, 5.3; total thyroidectomy, 5.4; P = .85). The percentage of adults who had a high level of cancer-related fear declined from 64.9% at baseline to 50.9% at follow-up, and the proportion of those with a high level of cancer-related worry dropped from 75.4% at baseline to 41.2% at 9 months (P < .001 for both). Adults who had increases in fear or worry at follow-up had a higher rate of nodule metastases found during their procedure compared with adults who did not have fear or worry scores increase (44.4% vs. 23.9%; P = .09).
“It was initially surprising to see similar thyroid cancer-related fear and worry scores prior to a hemithyroidectomy or total thyroidectomy, as our prior qualitative work suggests that many patients choose a total thyroidectomy because they anticipate greater peace of mind with the entire thyroid removed,” Pitt told Healio. “However, our results here reinforce the findings that removal of cancer, regardless of the extent, is emotionally beneficial to some patients.”
Stephanie Lee, BS, the study’s lead author and a medical student at the University of Michigan, said more research is needed to assess which factors drive a person’s decision for thyroid cancer surgery.
“Additionally, further research on effective interventions to support patients with high levels of fear and worry prior to treatment and decision-making may be helpful to further guide clinicians when counseling patients,” Lee told Healio.
For more information:
Stephanie Lee, BS, can be reached at leesteph@med.umich.edu.
Susan C. Pitt, MD, MPHS, can be reached at scpitt@med.umich.edu.
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Lee S, et al. J Clin Endocrinol Metab. 2024;doi:10.1210/clinem/dgae688.
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