BACKGROUND
The number of new cases of differentiated thyroid cancer, the most common endocrine cancer, has been increasing over the past several years. A diagnosis of cancer has many significant implications to patients, including concerns about death and the need for strong chemotherapy drugs that cause one to lose their hair. While thyroid cancer patients usually need to undergo surgery, the majority of patients do well and have an excellent prognosis. The risk of death due to differentiated thyroid cancer is very low and very few patients require strong chemotherapy drugs. Despite this, previous studies have shown that thyroid cancer patients have decreased health-related quality of life (HRQoL) compared to the general population, and surprisingly similar to that of patients with more aggressive cancers. This study evaluated changes in HRQoL over time and the factors at diagnosis that may predict HRQoL at one-year follow up.

THE FULL ARTICLE TITLE:
Hedman C et al. Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study. Thyroid. 2018 Oct 26;28(12):1609-1617.

SUMMARY OF THE STUDY
The study authors surveyed 487 Swedish patients diagnosed with differentiated thyroid cancer between 2012 and 2017. Information collected included patient characteristics, concurrent diseases, fear of the cancer coming back and view of life. Survey questions were included to assess HRQoL. Additionally, cancer characteristics, treatments and lab results were obtained from the patients’ medical records.

Overall, 72% of patients responded to the survey at diagnosis. Of the respondents that had at least one year follow up, 94% returned both surveys. Of the respondents, 70% were women and the mean age was 51 years old. The study found that HRQoL improved at the one-year follow up compared to diagnosis. Factors that were associated with decreased HRQoL at follow up included being older than 50 years old, lower education, living alone, having other concurrent diseases, a negative view of life and fear of recurrence at diagnosis. Report of lower HRQoL at diagnosis significantly predicted a lower HRQoL at the one-year follow up.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study found that even though the majority of thyroid cancer patients have a good prognosis and are cured of their cancer, they still may have a decreased health-related quality of life at diagnosis which somewhat improves one year later. A negative view of life and fear of the cancer coming back at diagnosis had a negative impact on quality of life. Physicians should make efforts to lessen worry in low risk disease-free thyroid cancer patients in order to improve their quality of life. Additionally, special attention and support should be given to those most vulnerable, such as older patients, as those patients that have decreased quality of life at the time of diagnosis and those that live alone.

— Maria Papaleontiou, MD

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