Thyroid Cancer-specific Quality Research Articles

Developing a large-scale quality improvement program for thyroid cancer surgery.

Surgical quality improvement (QI) plays a critical role in optimizing patient outcomes and reducing healthcare costs. QI programs focusing specifically on thyroid cancer surgical care are lacking. This study aimed to (a) select and introduce surgical quality indicators for thyroid cancer and (b) identify areas for QI at the state-level. A multidisciplinary team of thyroid cancer and QI experts selected 10 thyroid cancer-specific quality indicators and assessed the quality of thyroid cancer surgical care compared to current national guidelines. Analysis of the first year (January-December 2023) of data collection was performed using descriptive statistics. The thyroid cancer quality indicators included preoperative cytology, postoperative pathology, staging, cancer size, margin status, extrathyroidal extension, lymph nodes, postoperative complications within 30days, documented follow-up treatment, and documented surveillance plans. 112 surgeons performed 360 thyroidectomies for thyroid cancer at 51 hospitals. Preoperative cytology was not performed in 34.3% (n=103) of cases with thyroid cancer on final pathology. When the extent of surgery was evaluated by papillary cancer size, 50.0% (n=38) of patients with <1cm cancers underwent total thyroidectomy, and 13.8% (n=4) with >4cm underwent thyroid lobectomy. Positive margins were found in 16.2% (n=53). Postoperatively, 19.2% (n=69) of patients lacked documented follow-up, and 18.6% (n=67) lacked thyroid cancer surveillance plans. Establishing a dedicated QI program for thyroid cancer provides a previously unharnessed opportunity to enhance the quality of thyroid cancer surgical care. Statewide surgical quality collaboratives offer a model for establishing thyroid cancer QI initiatives across diverse healthcare settings in other states and countries.

Status of mental and social activities of young and middle-aged patients after papillary thyroid cancer surgery.

Papillary thyroid cancer (PTC) is prevalent among younger populations and has a favorable survival rate. However, a significant number of patients experience psychosocial stress and a reduced quality of life (QoL) after surgical treatment. Therefore, comprehensive evaluations of the patients are essential to improve their recovery. The present study enrolled 512 young and middle-aged patients diagnosed with PTC who underwent surgery at our institution between September 2020 and August 2021. Each participant completed a series of questionnaires: Generalized Anxiety Disorder 7 (GAD-7), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL), and Readiness to Return-to-Work Scale (RRTW). GAD-7 data showed that almost half of the study subjects were experiencing anxiety. Regarding health-related quality of life (HRQoL), participants reported the highest levels of fatigue, insomnia, voice problems, and scarring, with patients in anxious states reporting worse symptoms. Based on RRTW, more than half of the subjects had returned to work and had better HRQoL compared to the others who were evaluating a possible return to work. Age, gender, BMI, education, diet, residence, health insurance, months since surgery, monthly income, and caregiver status were significantly correlated with return to work. Additionally, having a caregiver, higher monthly income, more time since surgery, and living in a city or village were positively associated with return to work. Young and middle-aged patients with PTC commonly experience a range of health-related issues and disease-specific symptoms following surgery, accompanied by inferior psychological well-being, HRQoL, and work readiness. It is crucial to prioritize timely interventions targeting postoperative psychological support, HRQoL improvement, and the restoration of working ability in PTC patients.

A Long-Term Study Comparing the Quality of Life and Psychological Status of Patients with Highly Suspicious Thyroid Nodules ≤1 cm Undergoing Active Surveillance with Those Undergoing Immediate Surgery.

Background: Limited information is available on the long-term impact of active surveillance (AS) and immediate surgery (IS) on the quality of life (QoL) and psychological status of patients with highly suspicious subcentimeter thyroid nodules. Methods: A prospective study was conducted on 752 patients showing highly suspicious subcentimeter thyroid nodules, among whom 584 chose AS and 168 chose IS. All patients underwent at least two assessments regarding their QoL and psychological status, using three questionnaires: Thyroid Cancer-Specific Quality of Life (THYCA-QoL), Hospital Anxiety and Depression Scale (HADS), and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30). Propensity-score matching (PSM) at a ratio of 3:1 was utilized on patients in the AS and IS groups to mitigate selection bias (504 patients in the AS group and 168 in the IS group). Subsequently, the mixed linear model was used to analyze the QoL data. Results: The median time from the initial evaluation to the last follow-up in the AS and IS groups was 24.0 and 14.2 months, respectively. The AS group showed superior QoL outcomes compared to the IS group, mainly manifested in voice (p < 0.001), sympathetic (p = 0.008), throat/mouth (p < 0.001), and problems with scar (p < 0.001) domains, as per the THYCA-QoL questionnaire. Further, the EORTC QLQ-C30 questionnaire highlighted better outcomes in physical function (p = 0.029), role function (p < 0.001), social function (p < 0.001), global health status (p < 0.001), fatigue (p = 0.012), pain (p = 0.028), appetite loss (p = 0.017), and financial difficulties (p < 0.001). Compared to the initial assessment (1 week after surgery), the IS group showed progressive improvements in QoL, especially in voice (p = 0.024), throat/mouth (p < 0.001), physical function (p = 0.004), social function (p = 0.014), nausea and vomiting (p < 0.001), pain (p = 0.006), and appetite loss (p = 0.048) domains as per both questionnaires. Conclusion: Patients with highly suspicious subcentimeter thyroid nodules who choose IS tend to experience a poorer long-term QoL compared to those who choose AS. Although the situation may improve over time, certain issues might persist, making AS a favorable option for these patients.

Comparison between thermal ablation and surgery in low risk papillary thyroid carcinoma: a prospective study.

To conduct a comparative analysis of the efficacy, safety, and impact on quality of life outcomes between thermal ablation and surgical interventions in patients diagnosed with papillary thyroid carcinoma (PTC). A prospective study was undertaken, enrolling patients with PTC ≤5mm who underwent radiofrequency ablation (RFA), laser ablation (LA), or surgery, for analysis of efficacy and safety outcomes. The Thyroid Cancer-Specific Quality of Life questionnaire was administered to all patients before treatment and at 3, 6, and 12 months post-treatment. A total of 162 eligible patients were included in the study. Major complications were not observed in the RFA and LA groups, while five cases were reported in the surgery group, although no statistically significant differences were observed. Minor complications were documented in two, three, and 14 patients in the RFA, LA, and surgery groups, respectively, with no significant variances noted. Surgical duration and hospitalization time were notably shorter in the thermal ablation groups. At the final follow-up, complete disappearance of nodules was seen in 71.4% of cases treated with RFA and 71.0% of cases managed with LA, with no significant disparities between the groups. Both RFA and LA exhibited similar effects on quality of life, with thermal ablation techniques showing better functional outcomes in comparison to surgery. Across all groups, adverse effects were most pronounced at the 3-month post-treatment mark but gradually reverted to baseline levels in the thermal ablation group, contrasting with the surgery group. For PTC ≤5mm, both RFA and LA exhibited similar cancer control outcomes and superior quality of life on par with surgery, while minimizing complications. These findings underscore the promise of RFA and LA as potential standard treatments for small PTCs, subject to further confirmation in future studies.

Assessment of preoperative health-related quality of life in patients undergoing thyroidectomy based on patient-reported outcomes.

To evaluate the preoperative health-related quality of life (HRQoL) and influencing factors of HRQoL in patients undergoing thyroidectomy based on patient-reported outcomes. Patients who were diagnosed and treated in Sichuan Cancer Hospital from February 2022 to December 2022 and were scheduled to undergo thyroidectomy were included. Each participant completed the basic information questionnaire and patient-reported outcome assessment scales before surgery. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), the Thyroid Cancer-Specific Quality of Life (THYCA-QoL), and the Hamilton Anxiety Scale (HAMA). The Wilcoxon rank sum test or the Kruskal-Wallis test was used to analyze the association between patient characteristics and HRQoL, and the variables with statistical significance were included in multiple linear regression analysis. 450 patients were included in the study. According to the analysis of the THYCA-QoL scores, the psychological subscale was the most complained about. Anxiety was the most common symptom of the HAMA. Factors associated with worse general QoL on the EORTC QLQ-C30 included nondiagnostic/unsatisfactory fine-needle aspiration (FNA) result. Planned lateral neck dissection and nondiagnostic/unsatisfactory FNA result were influential factors for preoperative anxiety. Males and longer sleep duration were associated with better thyroid cancer-specific QoL, better general QoL, and less anxiety. The preoperative HRQoL of patients undergoing thyroidectomy was generally good. Females, insufficient sleep duration, planned lateral neck dissection, and nondiagnostic/unsatisfactory FNA result were associated with worse preoperative HRQoL.

Validation of the Indonesian version of the thyroid cancer-specific quality of life as a tool to assess the quality of life among pediatric thyroid cancer patients

BackgroundDiagnosis and management of pediatric cancer develop a major life event that might impact psychosocial functioning and quality of life (QoL) even long after the initial therapy has been completed. Treatment outcomes have been measured in terms of survival time, but they also significantly impact survivors’ quality of life. The pediatric differentiated thyroid carcinoma survivors’ QoL has rarely been evaluated. This study aims to translate and validate the Indonesian version of the ThYCA-QoL questionnaire.ResultsThe median age of 105 eligible survivors was 20.88 years old. Eighty percent of the survivors were female, were married or in a relationship (86.7%), and had paid jobs or were full-time students (71.7%). The median follow-up time was 64.82 months. Cronbach-α co-efficient was > 0.70 for psychological, concentration, throat, and mouth problems. For sympathetic, neuromuscular, voice, and sensory, the scores were < 0.70, where a multi-trait scaling analysis showed that all item correlations were > 0.40. Validity was assessed using the Pearson correlation coefficient for y-QoL with r > 0.60 and p < 0.01.ConclusionsThe Indonesian ThYCA-QoL questionnaire is a reliable and valid tool to evaluate pediatric patients’ QoL after treatment. This simple assessment tool can be used to evaluate and manage pediatric thyroid cancer patients’ HRQoL.

A comparative study of quality of life in patients with papillary thyroid carcinoma undergoing microwave ablation vs. Total thyroidectomy

Objective To compare the health-related quality of life (HRQoL) of patients with T1N0M0 papillary thyroid carcinoma (PTC) who underwent microwave ablation (MWA) and those who underwent total thyroidectomy (TT). Materials and methods From February 2018 to February 2022, 180 T1N0M0 PTC patients were enrolled in present study, including 90 in the MWA group and 90 in the TT group, respectively. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) were completed by patients to evaluate their HRQoL scores Results According to the results of the EORTC-QLQ-C30, there was a significant difference in the scores of global health, physical, emotional, etc. between the two groups, which indicated that the quality of life in these items in the MWA group was better than those in the TT group (all p < 0.05). According to the results of the THYCA-QoL, all items had significant differences between the two groups except for headache, which demonstrated the thyroid-specific quality of life was higher in the MWA group than in the TT group (all p < 0.05). Conclusion Ultrasound (US)-guided MWA offers a significant advantage in HRQoL over TT in T1N0M0 PTC patients, which provides an important reference for MWA as an alternative strategy to TT.

Trajectory analysis of microwave ablation treatment effect on the quality of life and emotional distress in patients with papillary thyroid cancer.

Trajectory changes of quality of life (QOL) and psychological status in patients with T1N0M0 papillary thyroid cancer (PTC) after microwave ablation (MWA) treatment. Patients with T1N0M0 PTC who underwent MWA from March to August 2021 were included in this study. Patients completed the European Organisation for Research and Treatment of Cancer questionnaire (QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QOL) and Hospital Anxiety and Depression Scale (HADS) at baseline, 3 months, 6 months, 9 months and 12 months after MWA. 181 patients were enrolled in this study. All patients met a minimum of 12 months of follow-up. The QOL at baseline and 12 months after MWA were 14.95 ± 1.78 and 14.19 ± 1.73 (P < 0.01), respectively. Patients' anxiety was 3.33 ± 1.81 and 1.49 ± 2.14 (P < 0.01), respectively. Patients' depression was 2.14 ± 2.10 and 1.40 ± 2.22 (P < 0.01), respectively. In the trajectory analysis, 73%, 19% and 8% of patients achieved significant improvement, slight improvement and stable in QOL, respectively, with older, female, lower education and lower monthly income as the risk factors of QOL. 63%, 31% and 6% of patients achieved significant improvement, slight improvement and stable in anxiety, respectively, with younger, female, lower education, lower monthly income, unmarried or divorced and higher T3, T4 levels as the risk factors of anxiety. 72%, 21% and 7% of patients achieved significant improvement, slight improvement and stable in depression, respectively, with younger, lower monthly income and unmarried or divorced as the risk factors of depression. MWA can effectively improve the QOL and emotional distress of patients with T1N0M0 PTC.

Comparison of health-related quality of life and cosmetic outcome between traditional gasless trans-axillary endoscopic thyroidectomy and modified gasless trans-axillary endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma.

Gasless trans-axillary endoscopic thyroidectomy (GTET) has been proved to provide better cosmetic results; however, it has limitations as dissection of central neck lymph nodes is difficult. We developed a modified approach (MGTET-modified GTET) and compared it with the traditional one in terms of patients' health-related quality of life (HRQoL) and cosmetic results in order to provide more convincing therapeutic results. Between January 2021 and June 2021, 100 cN0 patients who had a confirmed diagnosis of papillary thyroid microcarcinoma were randomized to undergo either MGTET (n = 50) or GTET (n = 50). These two groups' baseline characteristics, intraoperative and postoperative findings, were compared. The Patient and Observer Scar Assessment Scale (POSAS) was determined 6 months after surgery. Thyroid Cancer-Specific Quality of Life Questionnaire was used to assess HRQoL at 1, 3, 6, and 12 months after surgery. M-GTET was associated with a larger number of lymph nodes dissected (p < 0.001), lower drainage volume (p < 0.001), shorter hospital stay (p < 0.001), and shorter axillary incision (p < 0.001). POSAS was more favorable in M-GTET. HRQoL was significantly better for MGTET in terms of less problems with scar (p < 0.001). Our study suggests that MGTET provides better therapeutic, cosmetic, and HRQoL outcomes.

A comparative study for the efficacies of transaxillary non-inflatable endoscopic surgery versus traditional surgery for papillary thyroid carcinoma

Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

Health-Related Quality of Life and Thyroid Cancer-Specific Symptoms in Patients Treated for Differentiated Thyroid Cancer: A Single-Center Cross-Sectional Survey from Mainland China.

Background: The incidence of differentiated thyroid cancer in Mainland China has increased rapidly in recent years, yet the number of studies focusing on health-related quality of life (HR-QOL) is still limited. Additionally, some of the quality-of-life (QOL) issues specific to thyroid cancer have not been adequately described. The aims of this study were to assess the generic and disease-specific HR-QOL of differentiated thyroid cancer survivors and to identify the associated factors. Methods: A cross-sectional survey including 373 patients was conducted in Mainland China. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QOL), and a questionnaire on patient demographics and clinical characteristics. Results: The QLQ-C30 global mean score was 73.12 (standard deviation [SD] = 11.95), while the THYCA-QOL summary mean score was 34.50 (SD = 12.68). The two QLQ-C30 functional subscales with the lowest scores were the social functioning and role functioning subscales. The five symptom subscales of the THYCA-QOL with the highest scores were the subscales regarding less interest in sex, problems with scar, psychological problems, voice problems, and sympathetic problems. Factors associated with worse global QOL on the QLQ-C30 included a shorter time since completing primary treatment (≤6 months), a history of lateral neck dissection, and a lower current thyrotropin (TSH) level (≤0.5 mIU/L). Higher cumulative activities of radioiodine (RAI; >100 mCi), gender (women), postoperative hypoparathyroidism, and a history of lateral neck dissection were associated with worse thyroid cancer-specific QOL. In contrast, higher monthly household income (>5000￥) and a history of minimally invasive thyroid surgery were associated with better thyroid cancer-specific QOL. Conclusions: Thyroid cancer patients experience multiple health-related problems and disease-specific symptoms after completing primary treatment. Patients with a duration ≤6 months from the completion of primary treatment, those with a history of lateral neck dissection, and a current TSH level ≤0.5 mIU/L may be more likely to have impaired generic QOL. More thyroid cancer-specific symptoms may be associated with higher cumulative activities of RAI, gender (women), postoperative hypoparathyroidism, a history of lateral neck dissection, lower monthly household income, and conventional surgery.

Comparison of quality of life and cosmetic result between open and transaxillary endoscopic thyroid lobectomy for papillary thyroid microcarcinoma survivors: A single-center prospective cohort study.

Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12months after surgery using the Patient and Observer Scar Assessment Scale (POSAS). No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001). During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12months postoperatively. The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.

Thyroid Cancer-Specific Health-Related Quality of Life Questionnaire: Psychometric Properties of the Persian Version.

Background:Adverse effects related to treatment negatively affect the quality of life of patients with thyroid cancer. The current study aimed to evaluate the psychometric properties of the Persian version of the thyroid-cancer-specific health-related quality of life (TC-specific HRQoL) questionnaire among patients with thyroid cancer in Kerman province, Iran.Methods:This research was a cross-sectional study conducted on 240 patients with thyroid cancer in Kerman province from 2000 to 2015. The patients were selected through the census method and were asked to complete the thyroid-cancer-specific quality of life questionnaire. Data were analyzed by SPSS version 19.0 and LISREL version 8.80. The reliability of the Persian version was determined by Cronbach's α coefficient and the intraclass correlation coefficient (ICC). Exploratory and confirmatory factor analysis (CFA) was also conducted.Results:The Cronbach's α and ICCs were determined as 0.92 and 0.88, respectively. Five factors were extracted in the exploratory factor analysis with a total of 55.76% explained variance. Acceptable goodness of fit indices were found in CFA.Conclusions:The Persian version of the TC-specific HRQoL has sufficient psychometric properties and can be used to assess HRQoL among patients with thyroid cancer.

Association of Total Thyroidectomy or Thyroid Lobectomy With the Quality of Life in Patients With Differentiated Thyroid Cancer With Low to Intermediate Risk of Recurrence

Owing to the good prognosis of differentiated thyroid cancer (DTC), guidelines recommend total thyroidectomy (TT) or thyroid lobectomy (TL) as surgical treatment for DTC with low to intermediate risk of recurrence. However, the association of these surgeries with the health-related quality of life (HRQOL) of patients with DTC with low to intermediate risk of recurrence is unclear. To longitudinally compare the HRQOL of patients with DTC undergoing different surgeries. This prospective observational longitudinal cohort study enrolled patients diagnosed with DTC with low to intermediate risk of recurrence at the First Affiliated Hospital, Sun Yat-sen University, China, from October 1, 2018, to September 31, 2019. Eligible patients were categorized into TL and TT groups according to the surgery they underwent. They were evaluated preoperatively and followed up at 1, 3, 6, and 12 months postoperatively using 3 HRQOL-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, version 3.0; Hospital Anxiety and Depression Scale; and Thyroid Cancer-Specific Quality of Life Questionnaire); serum thyrotropin levels, complications, and patient satisfaction were also monitored. Data were analyzed to compare the HRQOL of patients undergoing different surgeries at different time points. Total thyroidectomy or TL. The primary end point was HRQOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, version 3.0; Hospital Anxiety and Depression Scale; and Thyroid Cancer-Specific Quality of Life Questionnaire) at different time points, and the secondary end points were postoperative complications, thyrotropin level, and patient satisfaction. Of the 1060 eligible patients, 563 underwent TL (438 women [77.8%]; median [IQR] age, 38 [31-45] years), and 497 underwent TT (390 women [78.5%]; median [IQR] age, 38 [32-48] years). Compared with the TL group, including the 1- to 4-cm tumor subgroup, the TT group experienced more postoperative HRQOL problems at 1 and 3 months postoperatively. However, nearly all the differences disappeared at 6 and 12 months postoperatively. Results of this study suggest that HRQOL of patients with DTC with low to intermediate risk of recurrence is not associated with the extent of surgery, and HRQOL may not be an important consideration when making surgical decisions. If better HRQOL is requested in the short term, TL may be preferred.

Health-related quality of life after transoral robotic thyroidectomy in papillary thyroid carcinoma

BackgroundHealth-related quality of life after transoral robotic thyroidectomy has not been evaluated thoroughly. The purpose of this study was to compare health-related quality of life after transoral robotic thyroidectomy and after conventional thyroidectomy. MethodsThis study is a prospective, cross-sectional, and observational study of 114 patients who underwent transoral robotic thyroidectomy (57 patients) or conventional transcervical thyroidectomy (57 patients) for the treatment of papillary carcinoma. We used 2 questionnaires: the University of Washington Quality of Life questionnaire for head and neck cancer and the thyroid cancer–specific Quality of Life questionnaire (Thyroid Version). The survey was performed preoperatively, and 3 months and 1 year after thyroidectomy. ResultsMean scores for neck appearance were higher after surgery in the transoral robotic thyroidectomy group than the conventional group at both 3 months and 1 year. Anxiety was significantly improved after surgery in both groups. Total scores for health-related quality of life after surgery were similar in both groups. Health-related quality of life and overall quality of life over the previous 7 days as measured by the University of Washington Quality of Life questionnaire were significantly better at 1 year than in the preoperative period in both groups. Before surgery, patients in the both groups regarded anxiety and mood as the most important aspects of health-related quality of life. After surgery, patients in the transoral robotic thyroidectomy group identified anxiety, mood, and speech as the most significant issues, while patients in the conventional group selected anxiety, mood, and neck appearance. ConclusionQuality of life related to neck appearance is higher after transoral robotic thyroidectomy than after transcervical thyroidectomy. However, total scores for health-related quality of life did not differ in the 2 groups after surgery.

Health-Related Quality of Life in Asian Differentiated Thyroid Cancer Survivors.

Background:Health-related quality of life (HRQoL) is important for differentiated thyroid cancer survivors, but data for Asian survivors is lacking. This study aimed to have an overview of, and identify any disease-or treatment-related factors associated with, HRQoL in Asian differentiated thyroid cancer survivors.Patients and Methods:Thyroid cancer survivors were recruited from the thyroid clinics at Queen Mary Hospital, Hong Kong from February 2016 to December 2016. All adult differentiated thyroid cancer patients with stable disease more than or equal to 1 year received a survey on HRQoL using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid cancer specific quality of life (THYCA-QoL) questionnaire. Clinical information was collected retrospectively from the computerized clinical management system. To identify factors associated with poor HRQoL, univariable and stepwise multivariable regression analysis were performed.Results:A total of 613 survivors completed the questionnaires (response rate: 82.1%; female: 80.1%; median survivorship: 7.4 years (range: 1.0-48.2 years)). The QLQ-C30 summary score mean was 84.4 (standard deviation (SD): 12.7) while the THYCA-QoL summary score mean was 39.9 (SD: 9.7). The 2 highest symptom subscales were fatigue (mean: 26.4, SD: 20.6) and insomnia (mean: 26.2, SD: 27.6). Factors associated with worse HRQoL included serum thyrotropin (TSH) greater than 1.0 mIU/L, unemployment, and concomitant psychiatric disorders. Concomitant psychiatric illness (n = 40/613, 6.5%) also showed significant association with most of the symptom and functional subscales.Conclusions:Fatigue and insomnia were the 2 most common symptoms experienced by our differentiated thyroid cancer survivors. Long-term survivorship care with monitoring serum TSH level, supporting return-to-work and screening for concomitant psychiatric disorders should be offered.

Medullary Thyroid Cancer Patient’s Assessment of Quality of Life Tools: Results from the QaLM Study

Background: Medullary thyroid cancer (MTC) is a neuroendocrine tumour and a rare variant of thyroid cancer with different aetiology, presentation and treatment to differentiated thyroid cancer. Currently available thyroid cancer-specific quality of life (QoL) tools focus on issues and treatments more relevant to patients with differentiated thyroid cancer and therefore may not address issues specific to a MTC diagnosis and cancer journey. Method: This prospective multicentre randomised study involved 204 MTC patients completing four quality of life questionnaires (QOLQ) and stating their most and least preferred. The questionnaires were a general instrument, the EORTC QLQ-C30, two disease-specific tools, the MD Anderson Symptom Inventory (MDASI) thyroid module and the City of Hope Quality of Life Scale/THYROID (amended) and the neuroendocrine questionnaire, EORTC QLQ-GINET21. Patients were randomised to complete the four questionnaires in one of 24 possible orders and then answered questions about which tool they preferred. The primary outcome measure was patients’ preferred QoL instrument for describing their concerns and for facilitating communication with their healthcare professional. Secondary analyses looked at differences between preferred QOLQs amongst patient subgroups (WHO performance status [0 and 1+], disease stage: early [T1–3, N0 or N1A], metastatic [T4, any T N1b] and advanced [any T any N M1], and type of MTC [sporadic and inherited]), identification of MTC patients’ least preferred questionnaire and clinicians’ views on the QoL tools in terms of their ability to highlight problems not otherwise ascertained by a standard clinical review. Results: No evidence of a difference was observed for most preferred QOLQ (p = 0.650). There was however evidence of a difference in least preferred questionnaire in the cohort of 128 patients who stated their least preferred questionnaire (p = 0.042), with 36% (46/128) of patients choosing the EORTC QLQ-GI.NET21 questionnaire. Subgroup analyses showed that there was no evidence of a difference in patients’ most preferred questionnaire in sporadic MTC patients (p = 0.637), patients with WHO PS 0 or 1+ (p = 0.844 and p = 0.423) nor when comparing patients with early, advanced local or metastatic disease (p = 0.132, p = 0.463 and p = 0.506, respectively). Similarly, subgroup analyses on patients’ least preferred questionnaires showed no evidence of differences in sporadic MTC patients (p = 0.092), patients with WHO PS 0 or 1+ (p = 0.423 and p = 0.276), nor in early or metastatic disease patients (p = 0.682 and p = 0.345, respectively). There was however some evidence to suggest a difference in least preferred questionnaire in patients with advanced local stage disease (p = 0.059), with 43% (16/37) of these patients choosing the EORTC QLQ-GI.NET21 questionnaire. Conclusions: MTC patients regardless of their performance status, disease aetiology and disease burden did not express a preference for any one particular questionnaire suggesting any of the tools studied could be utilized in this patient cohort. The least preferred questionnaire being a gastrointestinal NET specific tool suggests that diarrhoea was not a significant symptom and concern for the population studied.

MON-494 Quality of Life in Patients with Papillary Thyroid Microcarcinoma According to the Treatment: Total Thyroidectomy Versus Total Thyroidectomy with Radioactive Iodine Remnant Ablation

Background: Recently, the role of radioactive iodine (RAI) ablation in the treatment of low risk differentiated thyroid carcinoma (DTC), especially for papillary thyroid microcarcinoma (PTMC), is controversial. This study aims to compare quality of life (QoL) parameters in patients with PTMC underwent total thyroidectomy (TT) versus TT with RAI ablation. Methods: In this cross-sectional study, patients with PTMC who underwent TT with/without RAI remnant ablation were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: 12-item short-form health survey (SF-12), thyroid cancer specific quality of life (THYCA-QOL), and fear of progression (FoP). Results: The TT and TT with RAI groups comprised 107 and 183 patients, respectively. The TT with RAI group had significantly lower serum TSH level than TT group. However, after matching of TSH level between the groups (TT with RAI = 100, TT = 100), there was no significant difference in baseline characteristics. According to the SF-12, the score for general health showed significantly lower in TT with RAI group than TT group (p = 0.047). The THYCA-QOL also showed statistically significant difference in felt chilly score between the groups (p = 0.023). No significant differences in FoP scores were seen between the groups. Conclusion: Patients with PTMC underwent TT with RAI ablation experienced more health-related problems than those managed by TT alone. These findings support RAI ablation should be carefully determined in patients with low-risk DTCs.

Thyroid Cancer-Specific Quality of Life and Health-Related Quality of Life in Young Adult Thyroid Cancer Survivors.

There is a lack of health-related quality of life (HRQOL) research in thyroid cancer (TC) survivors, especially young adults (YAs). This study aims to assess the socio-demographic and clinical factors that most influence TC-specific QOL domains and estimate the impact of different health conditions on HRQOL in a large cohort of YA TC survivors. TC survivors ≥17 years of age were recruited through the thyroid cancer survivor (ThyCa) Web site. Mean scores for the seven domains and six items of THYCA-QoL, MCS and PCS of SF-12v1, and derived SF-6D were compared between factors as well as age groups (YA: 17-39 years, adult ≥40 years), and to the normal population. Regression analyses estimated the relationship between the socio-demographic, clinical, and THYCA-QoL measures and HRQOL in YAs only. Of 1028 survivors, 277 (27%) were YAs. Most YAs were female (93.5%), white (86.6%), insured (96.8%), married or in a stable relationship (69%), and listed a comorbidity (43.7%); all reported their entire thyroid had been removed. Average survivorship time was 46.2 months (SD = 51.0). Almost every socio-demographic and clinical factor significantly influenced one or more domain of THYCA-QoL in both YAs and older adults. In both groups, a higher level of education, female sex, unemployment, and having a comorbidity resulted in significantly higher THYCA-QoL scores (more complaints) and lower SF-6D scores (lower HRQOL; p < 0.05). Current YAs had less neuromuscular, voice, sympathetic, and throat/mouth complaints but more grievances involving their scar, headaches, anxiety, and overall psychological state (p < 0.05). The average SF-6D for YAs was 0.70 (SD = 0.13), which was similar to the older adults but significantly different from the normal age-matched population in females (p < 0.01). All THYCA-QoL domains were strongly associated with a lower HRQOL (adj R(2) > 0.5) in YAs. The simplest, best regression model (adj R(2) = 0.53) in YAs included neuromuscular, concentration, and anxiety complaints, as well as having a comorbidity predicting lower HRQOL. TC-specific QOL is significantly influenced by many socio-demographic and clinical factors. HRQOL is lower in female YA TC survivors compared with the normal age-matched population. Neuromuscular, concentration, and anxiety complaints had the greatest impact on HRQOL in YA TC survivors.

Validation of the Korean version of the thyroid cancer-specific quality of life questionnaire

PurposeThe increasing incidence of thyroid cancer worldwide has drawn attention to the needs for assessing and managing health-related quality of life (HRQoL) of thyroid cancer survivors. We conducted this study to validate the Korean version of the thyroid cancer-specific quality of life (THYCA-QoL) questionnaire.MethodsData obtained from 227 thyroid cancer survivors were analyzed using standard validity and reliability analysis techniques. Reliability was assessed by measuring internal consistency via Cronbach α coefficient, and validity was assessed by determining the Pearson correlation coefficient between the THYCA-QoL questionnaire and the following relevant assessment tools: the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30), the Korean version of Brief Fatigue Inventory (BFI-K), the Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), Goldberg Short Screening Scale for Anxiety and Depression, and a nine-item Patient Health Questionnaire (PHQ-9). A multitrait scaling analysis was performed to assess each item's convergent and discriminant validity.ResultsThe reliability of the THYCA-QoL questionnaire was confirmed by Cronbach α coefficients for multiple-item scales which ranged from 0.54 (sensory) to 0.82 (psychological). Except for a single item (sexual interest), the questionnaire's validity was established by significant correlation observed between scales in the THYCA-QoL questionnaire and scales used in other assessment tools. A multitrait scaling analysis confirmed that all scales met the recommended psychometric standards.ConclusionThe Korean version of the THYCA-QoL questionnaire is a reliable and valid assessment tool that can be used in combination with the EORTC QLQ-C30 to assess the HRQoL of thyroid cancer survivors in Korea.