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Ziamanesh F, Mohajeri Tehrani MR, Hemmatabadi M, Sharghi S, Fallahi B, Haghpanah V, Karamzade-Ziarati N, Larijani B, Shirzad N. Design and implementation of a national quality registry of thyroid cancer in Iran: study protocol. J Diabetes Metab Disord 2024; 23:1381-1386. [PMID: 38932868 PMCID: PMC11196499 DOI: 10.1007/s40200-023-01320-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/20/2023] [Indexed: 06/28/2024]
Abstract
Purpose Thyroid cancer is recognized as the predominant form of endocrine cancer. The likelihood of cancer recurrence and the development of distant metastases varies depending on the cancer's pathology and stage. Iran currently lacks country-specific data on thyroid cancer, which can potentially result in clinicians deviating from the optimal treatment. The primary objectives of establishing such a registry are to determine the incidence, identify risk factors, and evaluate treatment outcomes for thyroid cancer within the Iranian population. Ultimately, the overarching goal of this protocol study is to reduce mortality and morbidity rates among thyroid cancer patients by implementing appropriate interventions based on the findings derived from this registration system. Methods The study will enroll all individuals aged 18 years and older who have received a diagnosis of primary thyroid carcinoma based on pathology criteria. Data will be collected from various thyroid clinic centers. The participating centers include the Endocrinology Clinic at Shariati Hospital, the Thyroid Clinic in the Nuclear Medicine Center at Shariati Hospital, as well as pathology and nuclear medicine centers in Kerman and Bushehr. Patient records comprise information on outpatient visits to the clinic. Conclusion The registry aims to enhance treatment approaches and follow-up protocols while serving as a foundation for conducting clinical, epidemiological, and basic science studies based on robust evidence-based data.
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Affiliation(s)
- Fateme Ziamanesh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Hemmatabadi
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Keshavarz Boulevard, Tehran, 13145-784 Iran
| | - Sasan Sharghi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Haghpanah
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Keshavarz Boulevard, Tehran, 13145-784 Iran
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Thakur S, Azad RK, Chauhan I, Thakur JS. Long Term Health-Related Quality of Life with Differentiated Thyroid Cancer in Goiter Endemic Area. Indian J Otolaryngol Head Neck Surg 2023; 75:3130-3135. [PMID: 37974728 PMCID: PMC10645654 DOI: 10.1007/s12070-023-03936-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 11/19/2023] Open
Abstract
Health related quality of life (HRQOL) is a multidimensional concept that encompasses the patient's perceptions of his or her physical, emotional, social, and cognitive functions. Despite DTC patients' long survival, HRQOL has been shown to be lower than in the general population. There is a scarcity of data on HRQOL in thyroid cancer in the Indian population and especially goiter endemic area. As a result, the authors conducted a health-related quality of life survey in patients managed at their center in Northern India's Sub-Himalayan region using two widely accepted questionnaires. Adults with differentiated thyroid cancer who had surgery with or without radio-iodine ablation and had recovered for at least 6 months were assessed using health quality of life surveys, the QLQ-C30 and QLQ-THY34 of the European Organization for Research and Treatment of Cancer Quality of Life Group. The survey was completed by 57 adults with a mean age of 45.64 ± 15.64 years. The average time between the survey and treatment was 13.3 ± 10.8 months. After surgery, the QLQ-C30 found a significant reduction in insomnia, appetite loss, constipation, diarrhea, and financial difficulties, whereas radio-iodine ablation significantly improved global health status. The QLQ-THY34 found a significant increase in symptoms such as voice concerns, hair problems, dry mouth, shoulder functioning, tingling, and worrying after surgery, with a significant improvement in swallowing and job impact symptoms. The surgical extent had no impact. The quality of life for people with differentiated thyroid cancer in goiter-endemic areas is similar to that of other areas. However, the limited number of subjects in the study warrants further large sample size longitudinal study to understand the exact Health-related quality of life in thyroid cancer in endemic area.
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Affiliation(s)
- Sheetal Thakur
- Department of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, 171001 India
| | - Ramesh K. Azad
- Department of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, 171001 India
| | - Ishan Chauhan
- Department of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, 171001 India
| | - Jagdeep S. Thakur
- Department of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, 171001 India
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Roshanravan V, Sadeghi R, Zakavi SR, Norouzbeigi N, Aghaee A. Unilateral Chronic Parotitis With 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT Imaging in a Case of a Patient With Papillary Thyroid Carcinoma. Clin Nucl Med 2023; 48:e577-e579. [PMID: 37756475 DOI: 10.1097/rlu.0000000000004884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT The 68 Ga-FAPI (fibroblast activation protein inhibitor) radiotracer is a novel and versatile tool in nuclear medicine, exhibiting potential for use in various conditions due to its significant upregulation in cancerous and inflammatory conditions, particularly those involving fibrotic and infectious processes. In this report, we present the case of a patient with papillary thyroid carcinoma who underwent total thyroidectomy and iodine therapy. He was referred because of high thyroglobulin despite negative diagnostic radioiodine imaging (TENIS syndrome). The patient underwent 18 F-FDG and 68 Ga-DOTA-FAPI-46 PET/CT imaging for metastatic workup and treatment planning. FAPI uptake was observed in the right parotid gland (with no FDG uptake), prompting a 99m TcO 4- salivary scintigraphy. Subsequently, a diagnosis of chronic sialadenitis was made.
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Affiliation(s)
- Vahid Roshanravan
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences
| | - Ramin Sadeghi
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences
| | - Seyed Rasoul Zakavi
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences
| | - Nasim Norouzbeigi
- Nuclear Medicine Department, Razavi Hospital, Imam Reza International University, Mashhad, Khorasan Razavi, Iran
| | - Atena Aghaee
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences
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4
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Yaniv D, Vainer I, Amir I, Robenshtok E, Hirsch D, Watt T, Hilly O, Shkedy Y, Shpitzer T, Bachar G, Feinmesser R, Mizrachi A. Quality of life following lobectomy versus total thyroidectomy is significantly related to hypothyroidism. J Surg Oncol 2022; 126:640-648. [PMID: 35689620 PMCID: PMC9544480 DOI: 10.1002/jso.26983] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the differences in quality of life (QOL) following complete or partial thyroidectomy and with regard to thyroid hormone replacement (LT4) therapy. STUDY DESIGN Patients who underwent thyroidectomy were asked to complete the validated thyroid-specific ThyPRO QOL questionnaire at least 6 months following surgery. SETTING Tertiary medical center. METHODS Thyroid specific QOL questionnaire analysis. RESULTS A total of 190 patients completed the ThyPRO questionnaire. Of them 89 patients had complete thyroidectomy and 101 patients had unilateral thyroid lobectomy. The total thyroidectomy group had significantly worse overall QOL self-assessment score than the lobectomy patients (p < 0.0001). Patients receiving LT4 therapy regardless of the extent of surgery, reported worse QOL compared to patients not receiving LT4. CONCLUSIONS Quality of life following thyroid surgery is significantly related to hypothyroidism and the requirement for LT4 therapy, rather to the extent of surgery. The best QOL was reported in patients treated with lobectomy who did not require LT4 therapy.
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Affiliation(s)
- Dan Yaniv
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Vainer
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robenshtok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah Tikva, Israel
| | - Dania Hirsch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah Tikva, Israel
| | - Torquil Watt
- Department of Endocrinology, National University Hospital, Copenhagen, Denmark
| | - Ohad Hilly
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Shkedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Rambam Healthcare Campus, Technion-Israel Institute of Technology, Rappaport Faculty of Medicine, Haifa, Israel
| | - Thomas Shpitzer
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Feinmesser
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Jonklaas J. Impact of Nasolacrimal Dysfunction in Thyroid Cancer Survivors. Thyroid 2022; 32:483-485. [PMID: 35180829 PMCID: PMC9271331 DOI: 10.1089/thy.2022.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
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6
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Eilsberger F, Ahlers G, Luster M. Side effects of 131I therapy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Can Age at Diagnosis and Sex Improve the Performance of the American Thyroid Association Risk Stratification System for Prediction of Structural Persistent and Recurrent Disease in Patients With Differentiated Thyroid Carcinoma? A Multicenter Study. Endocr Pract 2021; 28:30-35. [PMID: 34508902 DOI: 10.1016/j.eprac.2021.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/09/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the age at diagnosis has been suggested as a major determinant of disease-specific survival in the recent TNM staging system, it is not included in the recent American Thyroid Association (ATA) guidelines to estimate the risk of recurrence. Nevertheless, the effect of sex on differentiated thyroid carcinoma (DTC) recurrence is controversial. Therefore, this multicenter study was conducted to assess whether age at diagnosis and sex can improve the performance of the ATA 3-tiered risk stratification system in patients with DTC with at least 5 years of follow-up. METHODS In this study, the computer-recorded data of the patients diagnosed with DTC between January 1985 and January 2016 were analyzed. Only patients with proven structural persistent/recurrent disease were selected for comparisons. RESULTS This study consisted of 1691 patients (female, 1367) with DTC. In Kaplan-Meier analysis, disease-free survival (DFS) was markedly longer in females only in the ATA low-risk category (P = .045). Nevertheless, a markedly longer DFS was observed in patients aged <45 years in the ATA low- and intermediate-risk categories (P = .004 and P = .009, respectively), whereas in patients aged <55 years, DFS was markedly longer only in the ATA low-risk category (P < .001). In the Cox proportional hazards model, ages of ≥45 and ≥55 years at diagnosis and the ATA risk stratification system were all independent predictors of persistent/recurrent disease. CONCLUSION Applying the age cutoff of 45 years in the ATA intermediate- and low-risk categories may identify patients at a higher risk of persistence/recurrence and may improve the performance of the ATA risk stratification system, whereas sex may improve the performance of only the ATA low-risk category.
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8
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Saqcena M, Leandro-Garcia LJ, Maag JLV, Tchekmedyian V, Krishnamoorthy GP, Tamarapu PP, Tiedje V, Reuter V, Knauf JA, de Stanchina E, Xu B, Liao XH, Refetoff S, Ghossein R, Chi P, Ho AL, Koche RP, Fagin JA. SWI/SNF Complex Mutations Promote Thyroid Tumor Progression and Insensitivity to Redifferentiation Therapies. Cancer Discov 2020; 11:1158-1175. [PMID: 33318036 DOI: 10.1158/2159-8290.cd-20-0735] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/16/2020] [Accepted: 12/09/2020] [Indexed: 12/21/2022]
Abstract
Mutations of subunits of the SWI/SNF chromatin remodeling complexes occur commonly in cancers of different lineages, including advanced thyroid cancers. Here we show that thyroid-specific loss of Arid1a, Arid2, or Smarcb1 in mouse BRAFV600E-mutant tumors promotes disease progression and decreased survival, associated with lesion-specific effects on chromatin accessibility and differentiation. As compared with normal thyrocytes, BRAFV600E-mutant mouse papillary thyroid cancers have decreased lineage transcription factor expression and accessibility to their target DNA binding sites, leading to impairment of thyroid-differentiated gene expression and radioiodine incorporation, which is rescued by MAPK inhibition. Loss of individual SWI/SNF subunits in BRAF tumors leads to a repressive chromatin state that cannot be reversed by MAPK pathway blockade, rendering them insensitive to its redifferentiation effects. Our results show that SWI/SNF complexes are central to the maintenance of differentiated function in thyroid cancers, and their loss confers radioiodine refractoriness and resistance to MAPK inhibitor-based redifferentiation therapies. SIGNIFICANCE: Reprogramming cancer differentiation confers therapeutic benefit in various disease contexts. Oncogenic BRAF silences genes required for radioiodine responsiveness in thyroid cancer. Mutations in SWI/SNF genes result in loss of chromatin accessibility at thyroid lineage specification genes in BRAF-mutant thyroid tumors, rendering them insensitive to the redifferentiation effects of MAPK blockade.This article is highlighted in the In This Issue feature, p. 995.
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Affiliation(s)
- Mahesh Saqcena
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Jesper L V Maag
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vatche Tchekmedyian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gnana P Krishnamoorthy
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasanna P Tamarapu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vera Tiedje
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent Reuter
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey A Knauf
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisa de Stanchina
- Antitumor Assessment Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiao-Hui Liao
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Samuel Refetoff
- Departments of Medicine and Pediatrics and the Committee on Genetics, The University of Chicago, Chicago, Illinois
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ping Chi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard P Koche
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Fagin
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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9
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Ahtiainen V, Vaalavirta L, Tenhunen M, Joensuu H, Mäenpää H. Randomised comparison of 1.1 GBq and 3.7 GBq radioiodine to ablate the thyroid in the treatment of low-risk thyroid cancer: a 13-year follow-up. Acta Oncol 2020; 59:1064-1071. [PMID: 32603613 DOI: 10.1080/0284186x.2020.1785003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The optimal activity of radioiodine (I-131) administered for ablation therapy in papillary and follicular thyroid cancer after thyroidectomy remains unknown in a long-term (> 10 year) follow-up. Some, shorter follow-up studies suggest that activities 1.1 GBq and 3.7 GBq are equally effective. We evaluated the long-term outcomes after radioiodine treatment to extend current knowledge about the optimal ablative dose of I-131.Methods: One hundred and sixty consecutive adult patients (129 females, 31 males; mean age 46 ± 14 y, range 18-89 y) diagnosed with histologically confirmed differentiated thyroid cancer, were randomised in a prospective, phase III, open-label, single-centre study, to receive either 1.1 GBq or 3.7 GBq of I-131 after thyroidectomy. At randomisation, patients were stratified according to the histologically verified cervical lymph node status and were prepared for ablation using thyroid hormone withdrawal. No uptake in the whole-body scan with I-131 and serum thyroglobulin concentration less than 1 ng/mL at 4-8 months after treatment was considered successful ablation.Results: Median follow-up time was 13.0 years (mean 11.0 ± 4.8 y; range 0.3-17.1 y). Altogether 81 patients received 1.1 GBq with successful ablation in 45 (56%) patients. In the original study, thirty-six patients (44%) needed one or more extra administrations to replete the ablation. Of these, 4 (8.9%) and 5 (14%) patients relapsed during the follow-up, respectively. Of the 79 patients treated with 3.7 GBq 45 (57%) had successful ablation after one administration of radioiodine and 34 (43%) needed several treatments. Of these, 2 (4.4%) and 9 (26.5%) patients relapsed, respectively. The groups did not differ in the proportion of patients relapsing (p = .591).Conclusion: During follow-up of median 13 years, 3.7 GBq is not superior to 1.1 GBq in the radioiodine treatment after thyroidectomy in papillary and follicular thyroid cancer.
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Affiliation(s)
- Veera Ahtiainen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Doctoral School in Health Sciences, University of Helsinki, Helsinki, Finland
| | - Leila Vaalavirta
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Tenhunen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Joensuu
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Mäenpää
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
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Protective Effect of Alpha-Lipoic Acid on Salivary Dysfunction in a Mouse Model of Radioiodine Therapy-Induced Sialoadenitis. Int J Mol Sci 2020; 21:ijms21114136. [PMID: 32531940 PMCID: PMC7312690 DOI: 10.3390/ijms21114136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/17/2022] Open
Abstract
Radioiodine (RI) therapy is known to cause salivary gland (SG) dysfunction. The effects of antioxidants on RI-induced SG damage have not been well described. This study was performed to investigate the radioprotective effects of alpha lipoic acid (ALA) administered prior to RI therapy in a mouse model of RI-induced sialadenitis. Four-week-old female C57BL/6 mice were divided into four groups (n = 10 per group): group I, normal control; group II, ALA alone (100 mg/kg); group III, RI alone (0.01 mCi/g body weight, orally); and group IV, ALA + RI (ALA at 100 mg/kg, 24 h and 30 min before RI exposure at 0.01 mCi/g body weight). The animals in these groups were divided into two subgroups and euthanized at 30 or 90 days post-RI treatment. Changes in salivary 99mTc pertechnetate uptake and excretion were tracked by single-photon emission computed tomography. Salivary histological examinations and TUNEL assays were performed. The 99mTc pertechnetate excretion level recovered in the ALA treatment group. Salivary epithelial (aquaporin 5) cells of the ALA + RI group were protected from RI damage. The ALA + RI group exhibited more mucin-containing parenchyma and less fibrotic tissues than the RI only group. Fewer apoptotic cells were observed in the ALA + RI group compared to the RI only group. Pretreatment with ALA before RI therapy is potentially beneficial in protecting against RI-induced salivary dysfunction.
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Looking under the hood of "the Cadillac of cancers:" radioactive iodine-related craniofacial side effects among patients with thyroid cancer. J Cancer Surviv 2020; 14:847-857. [PMID: 32506220 DOI: 10.1007/s11764-020-00897-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Despite having a generally favorable prognosis, differentiated thyroid cancer is known to have a significant, long-term impact on the quality of life of survivors. We wished to investigate short- and long-term effects among thyroid cancer survivors following radioactive iodine therapy. METHODS We conducted eight focus groups (N = 47) to understand patients' experiences of short- and long-term effects after radioactive iodine treatment and the impact these treatment-related side effects had on patients' quality of life. We elicited responses regarding experiences with side effects following radioactive iodine treatment, particularly salivary, lacrimal, and nasal symptoms. We transcribed audiotapes and conducted qualitative analyses to identify codes and themes. RESULTS We identified eight broad themes from the qualitative analyses. Themes reflecting physical symptoms included dry mouth, salivary gland dysfunction, altered taste, eye symptoms such as tearing or dryness, and epistaxis. Psychosocial themes included lack of knowledge and preparation for treatment, regret of treatment, and distress that thyroid cancer is labeled as a "good cancer." CONCLUSIONS Thyroid cancer survivors reported a wide range of radioactive iodine treatment-related effects and psychosocial concerns that appear to reduce quality of life. The psychosocial concerns reported by participants underscore the significant unmet information and support needs prior to and following RAI treatment among individuals diagnosed with thyroid cancer. IMPLICATIONS FOR CANCER SURVIVORS Future research is needed to help both patients and physicians understand the effect of radioactive iodine on quality of life, and to better assess the benefits versus the risks of radioactive iodine therapy.
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12
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Hughes DT, Reyes-Gastelum D, Kovatch KJ, Hamilton AS, Ward KC, Haymart MR. Energy level and fatigue after surgery for thyroid cancer: A population-based study of patient-reported outcomes. Surgery 2019; 167:102-109. [PMID: 31582311 DOI: 10.1016/j.surg.2019.04.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The relationship between treatment for differentiated thyroid cancer and patient-report of decreased energy and fatigue remains unclear. METHODS Patients diagnosed with differentiated thyroid cancer from 2014 to 2015 included in the Georgia and Los Angeles, California cancer registries of the Surveillance, Epidemiology, and End Results program were surveyed 2 to 4 years after diagnosis, and responses were linked to data from the Surveillance, Epidemiology, and End Results registry. Multivariable logistic regression analysis determined characteristics associated with the report of worse energy level at 2 to 4 years compared to before treatment and current fatigue severity using adjusted odds ratios with 95% confidence intervals. RESULTS Of the 2,584 respondents, 988 (38.2%) reported much worse or somewhat worse energy and 1,310 (50.7%) reported moderate to very severe fatigue. The majority of patients were treated with total thyroidectomy with or without nodal dissection (total thyroidectomy with lymph node removal [49.3%] or total thyroidectomy [38.3%]). Only 12.3% had a thyroid lobectomy. Just over half were treated with radioactive iodine therapy (56.7%) and thyroid hormone suppression (50.2%) after the thyroidectomy. Younger age, history of depression, thyroid hormone suppression (odds ratio 1.48 [confidence interval 1.21-1.82]), and receipt of radioiodine (odds ratio 1.31 [confidence interval 1.10-1.56]) correlated with worse energy. Similarly, correlates of substantial fatigue included younger age, more comorbidities, history of depression, and thyroid hormone suppression (odds ratio 1.63 [confidence interval 1.34-1.99]). The presence of low serum calcium levels for >3 months after thyroidectomy was associated with worse energy (odds ratio 1.26 [confidence interval 1.02-1.54]) and substantial fatigue (odds ratio 1.49 [confidence interval 1.21-1.84]). CONCLUSION In addition to accepted risk factors such as depression and comorbidities, receiving radioactive iodine and reporting low calcium after thyroidectomy for differentiated thyroid cancer were associated with reports of worse energy compared to preoperative levels; thyroid hormone suppression was associated with reports of both worse energy and substantial post-treatment fatigue.
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Affiliation(s)
- David T Hughes
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - David Reyes-Gastelum
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Megan R Haymart
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Kelly A, Barres B, Kwiatkowski F, Batisse-Lignier M, Aubert B, Valla C, Somda F, Cachin F, Tauveron I, Maqdasy S. Age, thyroglobulin levels and ATA risk stratification predict 10-year survival rate of differentiated thyroid cancer patients. PLoS One 2019; 14:e0221298. [PMID: 31425569 PMCID: PMC6699685 DOI: 10.1371/journal.pone.0221298] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/03/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Differentiated thyroid cancer (DTC) is the most common of endocrine cancers. Many studies have focused on recurrence-free survival of DTC patients, however, few studies have addressed overall survival rates. Given its very good prognosis, estimating overall or long-term survival in patients with DTC seems rational. So far, neither the impact of pre- and post-ablation thyroglobulin, nor that of initial American Thyroid Association (ATA) risk stratification on long-term disease-specific survival, have been sufficiently studied. OBJECTIVE The aim of this study was to determine the factors that influence long-term disease-specific survival and thyroglobulin levels in patients with DTC who have been previously treated with thyroidectomy and radioactive iodine (RAI) remnant ablation. PATIENTS AND METHODS This observational retrospective study included 1093 patients who were treated for DTC between 1995 and 2010 and are still monitored in our tertiary center. Only patients who needed RAI ablation after thyroidectomy were included in this study. Patients who were treated with RAI following rhTSH stimulation, patients who presented positive anti-thyroglobulin antibodies, and patients who had micro-cancers were excluded. Pre-ablation stimulated thyroglobulin (Pre-ablation sTg) was measured after thyroid hormone withdrawal (THW), just before RAI. RESULTS According to ATA standards, 29 patients (2.7%) were classified as high-risk patients. Initial ATA high-recurrence risk rating (HR 21.9; 95% CI: 8.5-56.3), age>55 years (HR 23.8; 95%-CI: 7.5-75.3) and pre-ablation sTg≥30 μg/l (HR 8.4; 95% CI: 4.6-15.3) significantly impacted ten-year survival. Moreover, age over 45 years, ATA moderate-risk and follicular DTC were also significant. Ten-year survival was lower in ATA high-risk patients (51% vs 95% and 93% for the low and intermediate risk; p<10-7), patients older than 55 years (82% vs 98%; p<10-7), and in patients with pre-ablation sTg≥30 (78% vs 95%; p<10-7). Three rates of long-term survival were distinguished: excellent (survival rate of 99% in patients<55 years with pre-ablation sTg <30μg/l) representing 59% of the cohort, moderate (survival rate of 94.5% in patients <55 years with pre-ablation sTg ≥30μg/l or ≥55 years with pre-ablation sTg <30 μg/l) representing 38% of the cohort, and low (survival rate of 49% in patients ≥55 years with pre-ablation sTg ≥30μg/l) representing 3% of the cohort. CONCLUSION Initial ATA high-risk classification, age over 55 years old and pre-ablation sTg ≥30 μg/l are the main negative factors that influence the ten-year survival in DTC. We suggest three categories of overall survival rates. Patients older than 55 years with pre-ablation sTg ≥30 μg/l have the worst survival rate.
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Affiliation(s)
- Antony Kelly
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
| | - Bertrand Barres
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
- UMR INSERM 1240 "Molecular Imaging and Theranostic Strategy", Clermont Auvergne University, Clermont-Ferrand, France
| | - Fabrice Kwiatkowski
- Département de recherche clinique, CLCC Jean Perrin, Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- CHU Clermont-Ferrand, Service d’endocrinologie, diabétologie et maladies métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, BP, Aubiere, France
| | - Bernadette Aubert
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
| | - Clémence Valla
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
| | - Frédéric Somda
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
| | - Florent Cachin
- Service de médecine nucléaire, CLCC Jean Perrin, Clermont-Ferrand, France
- UMR INSERM 1240 "Molecular Imaging and Theranostic Strategy", Clermont Auvergne University, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
| | - Igor Tauveron
- CHU Clermont-Ferrand, Service d’endocrinologie, diabétologie et maladies métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, BP, Aubiere, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
| | - Salwan Maqdasy
- CHU Clermont-Ferrand, Service d’endocrinologie, diabétologie et maladies métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, BP, Aubiere, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- * E-mail:
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Zavala LF, Barra MI, Olmos R, Tuttle M, González H, Droppelmann N, Mosso L, Domínguez JM. In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:293-299. [PMID: 31038590 PMCID: PMC10522203 DOI: 10.20945/2359-3997000000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. SUBJECTS AND METHODS This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. RESULTS Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. CONCLUSIONS In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.
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Affiliation(s)
- Luis Felipe Zavala
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Inés Barra
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Olmos
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael Tuttle
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New YorkUnited States
| | - Hernán González
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena Mosso
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Domínguez
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Ioannou LJ, Serpell J, Dean J, Bendinelli C, Gough J, Lisewski D, Miller JA, Meyer-Rochow W, Sidhu S, Topliss D, Walters D, Zalcberg J, Ahern S. Development of a binational thyroid cancer clinical quality registry: a protocol paper. BMJ Open 2019; 9:e023723. [PMID: 30782713 PMCID: PMC6352782 DOI: 10.1136/bmjopen-2018-023723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The occurrence of thyroid cancer is increasing throughout the developed world and since the 1990s has become the fastest increasing malignancy. In 2014, a total of 2693 Australians and 302 New Zealanders were diagnosed with thyroid cancer, with this number projected to rise to 3650 in 2018. The purpose of this protocol is to establish a binational population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. METHODS AND ANALYSIS The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) aims to capture clinical data for all patients over the age of 16 years with thyroid cancer, confirmed by histopathology report, who have been diagnosed, assessed or treated at a contributing hospital. A multidisciplinary steering committee was formed which, with operational support from Monash University, established the ANZTCR in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 20 sites expected to come on board across Australia in 2018. A modified Delphi process was undertaken to determine the clinical quality indicators to be reported by the registry, and a minimum data set was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery and 90-day follow-up. FUTURE PLANS The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand current practice in the treatment of thyroid cancer and identify variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer term outcome data particularly for patients with poor prognostic disease will add significant further value to the registry.
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Affiliation(s)
- Liane J Ioannou
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - Joanne Dean
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Jenny Gough
- Breast and Endocrine Surgery, The Wesley Hospital, Queensland, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Stan Sidhu
- Endocrine Surgery Unit, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Duncan Topliss
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - David Walters
- Breast and Endocrine Surgical Unit, University of Adelaide, The Queen Elizabeth Hospital, Sydney, New South Wales, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Liu J, Tang X, Shi F, Li C, Zhang K, Liu J, Wang G, Yin J, Li Z. Genetic polymorphism contributes to 131I radiotherapy-induced toxicities in patients with differentiated thyroid cancer. Pharmacogenomics 2018; 19:1335-1344. [PMID: 30430914 DOI: 10.2217/pgs-2018-0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM To investigate the association between SNPs in DNA damage response pathways and toxicities following 131I radiotherapy of differentiated thyroid cancer (DTC). Materials & methods: We identified 22 functional SNPs of genes in DNA damage response pathways. MassArray was used to sequence SNP genotypes in 203 DTC patients. Hardy-Weinberg equilibrium and the associations between the two alleles of each SNP and toxicity reactions were evaluated using χ2 analysis. RESULTS Ataxia-telangiectasia mutated (ATM) rs620815 T-allele carriers were at increased risk of 131I radiation-induced gastrointestinal reaction compared with C allele carriers. TNFα rs1800629 GA genotype may increase the incidence of neck pain compared with GG genotype. Furthermore, TNFα rs1800629, ATM rs11212570, NF-κβ rs230493, and TGF-β rs1800469, rs2241716 were associated with throat pain following 131I radiotherapy. CONCLUSION The identified SNPs might serve as novel biomarkers for DTC treated with 131I radiotherapy.
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Affiliation(s)
- Jianqiu Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Xinyue Tang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China.,Department of Center for ADR Monitoring of Hubei, Wuhan 430071, PR China
| | - Feng Shi
- Department of Thyroid internal medicine, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, PR China
| | - Cuilin Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Ke Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Jie Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Guo Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Jiye Yin
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Zhi Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
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Banerjee M, Reyes-Gastelum D, Haymart MR. Treatment-Free Survival in Patients With Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2018; 103:2720-2727. [PMID: 29788217 PMCID: PMC6692869 DOI: 10.1210/jc.2018-00511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cancer recurrence is a primary concern for patients with differentiated thyroid cancer; however, population-level data on recurrent or persistent disease do not currently exist. The objective of this study was to determine treated recurrent or persistent thyroid cancer by using a population-based registry, identify correlates of poor treatment-free survival, and define prognostic groups for treatment-free survival. METHODS In this population-based study, we evaluated treatment-free survival in 9273 patients from the Surveillance, Epidemiology, and End Results Program-Medicare with a diagnosis of differentiated thyroid cancer between 1998 and 2012. Treated recurrence was defined by treatment of recurrent or persistent differentiated thyroid cancer with surgery, radioactive iodine, or radiation therapy at ≥1 year after diagnosis. Multivariable analysis was performed with Cox proportional hazards regression, survival trees, and random survival forests. RESULTS In this cohort the median patient age at time of diagnosis was 69 years, and 75% of the patients were female. Using survival tree analyses, we identified five distinct prognostic groups (P < 0.001), with a prediction accuracy of 88.7%. The 5-year treatment-free survival rates of these prognostic groups were 96%, 91%, 85%, 72%, and 52%, respectively, and the 10-year treatment-free survival rates were 94%, 87%, 80%, 64%, and 39%. Based on survival forest analysis, the most important factors for predicting treatment-free survival were stage, tumor size, and receipt of radioactive iodine. CONCLUSION In this population-based cohort, five prognostic groups for treatment-free survival were identified. Understanding treatment-free survival has implications for the care and long-term surveillance of patients with differentiated thyroid cancer.
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Affiliation(s)
- Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - David Reyes-Gastelum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Megan R Haymart
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
- Correspondence and Reprint Requests: Megan R. Haymart, MD, Division of Metabolism, Endocrinology, and Diabetes, and Hematology/Oncology, University of Michigan Health System, North Campus Research Complex, 2800 Plymouth Road Building 16, Room 408E, Ann Arbor, Michigan 48109. E-mail:
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Smith S, Eatough V, Smith J, Mihai R, Weaver A, Sadler GP. 'I know I'm not invincible': An interpretative phenomenological analysis of thyroid cancer in young people. Br J Health Psychol 2018; 23:352-370. [PMID: 29356226 PMCID: PMC5901396 DOI: 10.1111/bjhp.12292] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/17/2017] [Indexed: 11/30/2022]
Abstract
Objective Thyroid cancer is one of the most common cancers affecting young people and carries an excellent prognosis. Little is known about the psychosocial issues that face young people diagnosed with a treatable cancer. This study explored how young people experienced diagnosis, treatment, and how they made sense of an experience which challenged their views on what it means to have cancer. Method Semi‐structured interviews were conducted with eight young people diagnosed with either papillary or follicular thyroid cancer, and analysed with interpretative phenomenological analysis (IPA). Results Two inter‐related aspects of their experience are discussed: (1) the range of feelings and emotions experienced including feeling disregarded, vulnerability, shock and isolation; (2) how they made sense of and ascribed meaning to their experience in the light of the unique nature of their cancer. A thread running throughout the findings highlights that this was a disruptive biographical experience. Conclusions Young people experienced a loss of youthful immunity which contrasted with a sense of growth and shift in life perspective. Having a highly treatable cancer was helpful in aiding them to reframe their situation positively but at the same time left them feeling dismissed over a lack of recognition that they had cancer. The young peoples’ experiences point to a need for increased understanding of this rare cancer, more effective communication from health care professionals and a greater understanding of the experiential impact of this disease on young people. Suggestions to improve the service provision to this patient group are provided. Statement of contribution What is already known on this subject? Differentiated thyroid cancer has an excellent prognosis. Quality of life of thyroid cancer has marginally been explored in the literature. Little is known on the support needs of young people diagnosed with thyroid cancer.
What does this study add? Increased understanding of how young people make sense and cope with thyroid cancer despite the lack of support resources. Addressing illness perceptions through improved information support may aid coping and adjustment. Insight into the needs of young people diagnosed with thyroid cancer and recommendations on service improvements.
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Affiliation(s)
- Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, UK
| | - Virginia Eatough
- Department of Psychological Sciences, Birkbeck University of London, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, UK
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Andrew Weaver
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Gregory P Sadler
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
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Mainthia R, Wachtel H, Chen Y, Mort E, Parangi S, Sadow PM, Lubitz CC. Evaluating the projected surgical impact of reclassifying noninvasive encapsulated follicular variant of papillary thyroid cancer as noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Surgery 2017; 163:60-65. [PMID: 29146229 DOI: 10.1016/j.surg.2017.04.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/14/2017] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer to noninvasive follicular thyroid neoplasm with papillary-like nuclear features will reduce nonefficacious and potentially harmful care. Reclassification is estimated in 18.6% of patients with papillary thyroid carcinoma; we aimed to quantify the implications of this change. METHODS Pathology reports from April 2006 to April 2016 were reviewed to isolate cases that would have been designated as neoplasm with papillary-like nuclear features. Of the 1,335 cases of papillary thyroid carcinomas, 194 cases (14.5%) met criteria. Cases in which neoplasm with papillary-like nuclear features was found in combination with other thyroid malignancies (n = 25) and cases of prior thyroid lobectomy (n = 5) were excluded. Demographic, pathologic, treatment, and follow-up data were assessed for the remaining 164 potential neoplasm with papillary-like nuclear features cases. Logistic regression analysis was performed to evaluate association between fine-needle aspiration result and index procedure. RESULTS Of the 164 patients with tumors who met neoplasm with papillary-like nuclear features criteria, fine-needle aspiration results were nondiagnostic (2%), benign (18%), atypia/follicular lesion of undetermined significance (26%), follicular neoplasm or suspicious for follicular neoplasm (20%), suspicious for malignancy (19%), malignant (6%), and not obtained (9%). Eighty-five (52%) patients underwent total thyroidectomy. A "suspicious for malignancy" fine-needle aspiration result was associated with undergoing total thyroidectomy versus thyroid lobectomy (P = .006). Thyroid lobectomy was the index procedure for 79 patients (48%); of these patients, 54% (n = 43, 3.2% of all patients with papillary thyroid carcinomas) underwent subsequent total thyroidectomy, and 24% received postoperative radioactive iodine treatment. There were no recurrences among the 125 patients with >3 months of follow-up. CONCLUSION The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer as neoplasm with papillary-like nuclear features will decrease nonefficacious treatment and reduce costs. However, the impact of this change with regard to extent of surgery was limited to 3.2% of patients with papillary thyroid carcinomas compared with the projected potential impact on 18.6%.
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Affiliation(s)
- Rajshri Mainthia
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Heather Wachtel
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yufei Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth Mort
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Institute for Technology Assessment, Boston, MA.
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Hamed RH. Is postoperative radioactive iodine associated with a survival advantage among…. FORUM OF CLINICAL ONCOLOGY 2017. [DOI: 10.1515/fco-2015-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Aim
This trial aimed to determine wether postoperative radioactive iodine(RAI) associated with a survival benefit among intermediate-risk Papillary Thyroid Cancer patients or not.
Methods
this study is a retrospective study of intermediate-risk papillary thyroid cancer patients that were treated with or without post operative RAI from 1st January 2002 till 1st January 2012. Overall survival (OS) and multivariate regression analyses were measured for all patients.
Results
100 patients were included in this trial : 70 patients received postoperative RAI and 30 patients did not. The mean follow-up time was 7.1 (4.8 -15.1 years), and a median survival time could not be estimated. Overall survival at 10 years was 96% in the RAI vs 93% in the group without RAI (P < .001). RAI reduced risk of death by a 27% [hazard risk (HR) 0.73, confidence interval (CI) 0.64 - 0.84, P < .001]. Older patient age, male gende, larger tumor size, multifocal tumors, lymph node metastases, aggressive histology, vascular invasion, positive surgical margin, minimal extrathyroidal extension and absence of postoperative RAI were accompanied by compromised OS (all P ≤ .001).
Conclusion
This representative study addresses the survival advantage of RAI for with intermediate risk PTC patients but conducting of large prospective randomized controlled trial is still warranted.
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Affiliation(s)
- Rasha Hamdy Hamed
- Clinical Oncology and Nuclear Medicine, Faculty of Medicine , Mansoura University , Mansoura , Egypt
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Lubitz CC, De Gregorio L, Fingeret AL, Economopoulos KP, Termezawi D, Hassan M, Parangi S, Stephen AE, Halpern EF, Donelan K, Swan JS. Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma. Thyroid 2017; 27:197-206. [PMID: 27824301 PMCID: PMC5314725 DOI: 10.1089/thy.2016.0260] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health-related quality of life (HRQoL) is an essential variable in the absence of a change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated, preference-based surveys detect changes in health and clinical intervention in patients diagnosed with papillary thyroid cancer (PTC). METHODS Four commonly used HRQoL questionnaires (Short Form-12v2® [SF6D], EuroQol-5D [EQ5D], and Health Utilities Index Mark 2 and 3 [HUI2, HUI3]) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years between the four instruments. RESULTS Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e., proportion with a perfect score) was greatest with EQ5D and least with SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at two weeks postoperatively and returned to pretreatment levels at six months. The SF6D was the only instrument to exceed the conventional minimally important difference between all three time points. Quality-adjusted life-years were as follows: SF6D, 0.79; EQ5D, 0.90; HUI2, 0.88; and HUI3, 0.86. CONCLUSIONS Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.
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Affiliation(s)
- Carrie C. Lubitz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Lucia De Gregorio
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abbey L. Fingeret
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Konstantinos P. Economopoulos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Diana Termezawi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mursal Hassan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia E. Stephen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elkan F. Halpern
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - J. Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Onimode YA, Ejeh JE, Orunmuyi AT. Adverse Reactions to Radioiodine 131I Therapy of Goiter in West African Tertiary Hospital. Mol Imaging Radionucl Ther 2016; 25:128-133. [PMID: 27751975 PMCID: PMC5100084 DOI: 10.4274/mirt.13007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/08/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Radioactive iodine therapy (RAIT) is established as an efficient means of treating toxic goiter (TG) globally. The field of nuclear medicine (NM) still appears novel to many Nigerian clinicians and patients. A culturally embedded dread of radiation may raise ethical and moral concerns about potential adverse effects in the wake of RAIT in our setting. An adverse drug reaction may be described as "a response to a drug which is noxious and unintended, and which occurs at doses normally used in man". This study therefore, seeks to review adverse reactions (ARs) experienced following RAIT. We would also like to improve patient and physician education about the safety profile of RAIT. METHODS This is a retrospective analysis of all patients who had received RAIT for thyroid disease from August 2006 to June 2015. RESULTS Forty typical ARs were experienced following 36 therapy sessions (18.65%) with RAIT in 35 patients (21.47%) aged 17-78 years, of which three had multiple sessions for well-differentiated thyroid carcinoma (WDTC). CONCLUSION RAIT remains a safe option for the treatment of benign and TG. The experienced ARs are mainly mild to moderate in severity and mostly short-lived. As larger doses of radioactive iodine for WDTC and TG were more commonly associated with ARs, our study suggests that these patients merit stronger prophylactic measures as well as closer monitoring for earlier detection and management of these reactions.
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Affiliation(s)
- Yetunde A Onimode
- University of Ibadan College of Medicine, Department of Radiation Oncology, Nuclear Medicine Unit, Ibadan, Nigeria, Phone: +2347087821065 E-mail:
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Applewhite MK, James BC, Kaplan SP, Angelos P, Kaplan EL, Grogan RH, Aschebrook-Kilfoy B. Quality of Life in Thyroid Cancer is Similar to That of Other Cancers with Worse Survival. World J Surg 2016; 40:551-61. [PMID: 26546191 DOI: 10.1007/s00268-015-3300-5] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The incidence of thyroid cancer is increasing. As such, the number of survivors is rising, and it has been shown that their quality of life (QOL) is worse than expected. Using results from the North American Thyroid Cancer Survivorship Study (NATCSS), a large-scale survivorship study, we aim to compare the QOL of thyroid cancer survivors to the QOL of survivors of other types of cancer. METHODS The NATCSS assessed QOL overall and in four subcategories: physical, psychological, social, and spiritual well-being using the QOL-Cancer Survivor (QOL-CS) instrument. Studies that used the QOL-CS to evaluate survivors of other types of cancers were compared to the NATCSS findings using two-tailed t tests. RESULTS We compared results from NATCSS to QOL survivorship studies in colon, glioma, breast, and gynecologic cancer. The mean overall QOL in NATCSS was 5.56 (on a scale of 0-10, where 10 is the best). Overall QOL of patients with thyroid cancer was similar to that of patients with colon cancer (mean 5.20, p = 0.13), glioma (mean 5.96, p = 0.23), and gynecologic cancer (mean 5.59, p = 0.43). It was worse than patients surveyed with breast cancer (mean 6.51, p < 0.01). CONCLUSIONS We found the self-reported QOL of thyroid cancer survivors in our study population is overall similar to or worse than that of survivors of other types of cancer surveyed with the same instrument. This should heighten awareness of the significance of a thyroid cancer diagnosis and highlights the need for further research in how to improve care for this enlarging group of patients.
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Affiliation(s)
- Megan K Applewhite
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA.
| | - Benjamin C James
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA
| | - Sharone P Kaplan
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA
| | - Peter Angelos
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA
| | - Edwin L Kaplan
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA
| | - Raymon H Grogan
- Endocrine Surgery Research Group, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC 4052, Chicago, IL, 60637, USA
| | - Briseis Aschebrook-Kilfoy
- Division of Epidemiology, Department of Health Studies, The University of Chicago, 5841 S. Maryland Ave. MC 2007, N112, Chicago, IL, 60637, USA.
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Lubitz CC, Sosa JA. The changing landscape of papillary thyroid cancer: Epidemiology, management, and the implications for patients. Cancer 2016; 122:3754-3759. [DOI: 10.1002/cncr.30201] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Carrie C. Lubitz
- Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital; Boston Massachusetts
| | - Julie A. Sosa
- Departments of Surgery and Medicine; Duke Cancer Institute, and Duke Clinical Research Institute, Duke University School of Medicine; Durham NC
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Florenzano P, Guarda FJ, Jaimovich R, Droppelmann N, González H, Domínguez JM. Radioactive Iodine Administration Is Associated with Persistent Related Symptoms in Patients with Differentiated Thyroid Cancer. Int J Endocrinol 2016; 2016:2586512. [PMID: 27867395 PMCID: PMC5102728 DOI: 10.1155/2016/2586512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Context. Radioiodine (RAI) administration has adverse effects in patients treated for thyroid cancer (DTC), but there is scarce information regarding their intensity and duration. Objective. To evaluate frequency and intensity of early and late RAI-related symptoms in patients with DTC. Design. Observational prospective study. Patients. DTC patients who underwent thyroidectomy, with or without RAI. Measurements. Patients answered 2 surveys: (1) from 0 to 6 months and (2) between 6 and 18 months after initial treatment. Results. 110 patients answered the first survey and 61 both. Nearly 80 percent received RAI. Among early symptoms, periorbital edema, excessive tearing, salivary gland disturbances, dry mouth, taste disorders, and nausea were more frequent and intense among RAI patients. Regarding late symptoms, periorbital edema, salivary gland pain and swelling, and dry mouth were more frequent and intense in RAI patients. Frequency and intensity of adverse effects were not different between low and high RAI doses (50 versus ≥100 mCi). Conclusion. RAI-related symptoms are frequent and usually persist after 6 months of administration, even when low doses are given. This finding must be considered when deciding RAI administration, especially in low risk patients, among whom RAI benefit is controversial.
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Affiliation(s)
- Pablo Florenzano
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco J. Guarda
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Jaimovich
- Department of Nuclear Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán González
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M. Domínguez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- *José M. Domínguez:
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Williams M, Hatipoglu B. Development of Abnormal Pigmentation of the Oral Mucosa Following Adjuvant Radioactive Iodine Treatment. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15670.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Aschebrook-Kilfoy B, James B, Nagar S, Kaplan S, Seng V, Ahsan H, Angelos P, Kaplan EL, Guerrero MA, Kuo JH, Lee JA, Mitmaker EJ, Moalem J, Ruan DT, Shen WT, Grogan RH. Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study. Thyroid 2015; 25:1313-21. [PMID: 26431811 PMCID: PMC4684649 DOI: 10.1089/thy.2015.0098] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The prevalence of thyroid cancer survivors is rising rapidly due to the combination of an increasing incidence, high survival rates, and a young age at diagnosis. The physical and psychosocial morbidity of thyroid cancer has not been adequately described, and this study therefore sought to improve the understanding of the impact of thyroid cancer on quality of life (QoL) by conducting a large-scale survivorship study. METHODS Thyroid cancer survivors were recruited from a multicenter collaborative network of clinics, national survivorship groups, and social media. Study participants completed a validated QoL assessment tool that measures four morbidity domains: physical, psychological, social, and spiritual effects. Data were also collected on participant demographics, medical comorbidities, tumor characteristics, and treatment modalities. RESULTS A total of 1174 participants with thyroid cancer were recruited. Of these, 89.9% were female, with an average age of 48 years, and a mean time from diagnosis of five years. The mean overall QoL was 5.56/10, with 0 being the worst. Scores for each of the sub-domains were 5.83 for physical, 5.03 for psychological, 6.48 for social, and 5.16 for spiritual well-being. QoL scores begin to improve five years after diagnosis. Female sex, young age at diagnosis, and lower educational attainment were highly predictive of decreased QoL. CONCLUSION Thyroid cancer diagnosis and treatment can result in a decreased QoL. The present findings indicate that better tools to measure and improve thyroid cancer survivor QoL are needed. The authors plan to follow-up on these findings in the near future, as enrollment and data collection are ongoing.
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Affiliation(s)
| | - Benjamin James
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Sapna Nagar
- Division of Endocrine Surgery, Department of General Surgery, Beaumont Hospitals, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Sharone Kaplan
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Vanessa Seng
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Habibul Ahsan
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Peter Angelos
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Edwin L. Kaplan
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Marlon A. Guerrero
- Department of Surgery, University of Arizona School of Medicine, Tucson, Arizona
| | - Jennifer H. Kuo
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - James A. Lee
- Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Elliot J. Mitmaker
- Department of Surgery and Oncology, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York
| | - Jacob Moalem
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Daniel T. Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wen T. Shen
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Raymon H. Grogan
- Endocrine Surgery Research Program, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab 2015; 100:1529-36. [PMID: 25642591 PMCID: PMC4399282 DOI: 10.1210/jc.2014-4332] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients. OBJECTIVE The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients. DESIGN/SETTING Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study. PATIENTS Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded. MAIN OUTCOME MEASURES Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured. RESULTS A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs 128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016). CONCLUSION This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.
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Affiliation(s)
- Ewa Ruel
- Department of Medicine (E.R., J.M.P.), Division of Endocrinology, Metabolism, and Nutrition, Department of Surgery (J.A.S.), Section of Endocrine Surgery, Duke University Medical Center, and Duke Cancer Institute (J.A.S.), Durham, North Carolina 27710; Department of Biostatistics (S.T.), Duke University, Durham, North Carolina 27708; and Duke Clinical Research Institute (M.D., J.A.S.), Durham, North Carolina 27705
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To J, Goldberg AS, Jones J, Zhang J, Lowe J, Ezzat S, Gilbert J, Zahedi A, Segal P, Sawka AM. A systematic review of randomized controlled trials for management of persistent post-treatment fatigue in thyroid cancer survivors. Thyroid 2015; 25:198-210. [PMID: 25382050 DOI: 10.1089/thy.2014.0418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Fatigue that persists post-treatment is commonly reported by thyroid cancer (TC) survivors. METHODS A systematic review of published English language randomized controlled trials (RCTs) on interventions for management of persistent post-treatment fatigue in TC was conducted. This review excluded studies on short-term interventions used in preparation for radioactive iodine diagnostic scans or treatment. An electronic search was executed in six databases and supplemented by a hand search. Two reviewers independently reviewed all citations from the electronic search and relevant full-text studies. Two abstractors independently critically appraised included studies and abstracted the data. The data were qualitatively summarized. RESULTS A total of 1086 unique citations and 25 full-text studies were reviewed. Four studies summarizing the results of three RCTs were included. The interventions included: combination triiodothyronine with levothyroxine (L-T4) therapy compared to L-T4 alone (one RCT), reduction in degree of thyrotropin (TSH) suppression using L-T4 compared to maintenance of TSH suppression (one RCT), and supervised exercise compared to inactivity (two RCTs examining different fatigue outcomes in same population). Trial duration ranged from 10 weeks to six months. All trials had limitations, and the number of TC survivors included in respective RCTs ranged from 15 to 36. Hormonal treatment RCTs had mixed fatigue outcome results within respective trials. However, multiple measures suggesting improvement in fatigue were reported following the exercise intervention. CONCLUSIONS There is paucity of RCTs to guide evidence-based management of persistent post-treatment fatigue in TC survivors. RCTs of interventions for prevention or treatment of fatigue in TC survivors are needed.
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Affiliation(s)
- Joshua To
- 1 Department of Psychology, University of Waterloo , Waterloo, Canada
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Jonklaas J, Wang H, Esposito G. Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy. Front Endocrinol (Lausanne) 2015; 6:100. [PMID: 26136724 PMCID: PMC4470264 DOI: 10.3389/fendo.2015.00100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/01/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Symptoms of salivary gland dysfunction frequently develop after radioactive iodine (RAI) therapy, but have generally not been correlated with assessment of salivary gland functioning. The aim of this study was to determine whether there was a correlation between salivary symptoms and salivary functioning as assessed by salivary scan parameters. METHODS This was a non-randomized observational study. Fifteen patients receiving RAI therapy for differentiated thyroid cancer completed a questionnaire assessing their salivary and nasal symptoms prior to their therapy and 3 and 12 months after their therapy. Salivary gland scanning using technetium-99m pertechnetate was performed at the same time points. In addition, protective measures used at the time of radioiodine administration, such as use of fluids and sour candy, were also documented. Measures of salivary gland accumulation and secretion were correlated with scores of salivary and nasal symptomatology and any effects of protective measures were assessed. RESULTS The mean number of salivary, nasal, and total symptoms at 3 months increased significantly over the number of symptoms at baseline by 3.7, 2.7, and 6.3 symptoms, respectively (p values 0.001, 0.0046, and <0.001, respectively). The mean increases in the number of salivary, nasal, and total symptoms at 12 months were non-significant at 1.3, 1.3, and 2.5 symptoms, respectively. The mean right parotid gland accumulation and secretion of radioisotope declined significantly at 3 months, compared with baseline. The changes in left parotid and right and left submandibular function were non-significant. There was no association between the increase in salivary, nasal, or total symptoms and the change in scintigraphy measures. However, the increases in nasal and total symptoms were significantly greater in those with co-existent Hashimoto's disease, compared with those without this condition (p values 0.01 and 0.04, respectively). Nasal symptoms decreased (p value 0.04) and total symptoms trended to decrease (p value 0.08) in those who used sour candies, compared with those who did not. Increasing body mass index was significantly associated with increasing nasal symptoms (p value 0.05). Greater decline in salivary parameters at 3 months compared with baseline was generally associated with heavier body weight, decreased thyroid cancer stage, absence of Hashimoto's thyroiditis, and pre-menopausal status. CONCLUSION Salivary and nasal symptoms increased and salivary scintigraphy parameters decreased after radioiodine therapy. However, the increased symptoms did not correlate with decrements in salivary gland accumulation or secretion. Moreover, the variables associated with symptoms and changes in salivary scan parameters differed. Therefore, a better understanding of the relationship between salivary gland symptoms and functioning is needed. Factors affecting susceptibility to salivary and nasal damage after radioiodine therapy need to be better elucidated, so that modifiable factors can be identified.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, DC, USA
- *Correspondence: Jacqueline Jonklaas, Division of Endocrinology, Georgetown University, Suite 230, Building D, 4000 Reservoir Road, NW, Washington, DC 20007, USA,
| | - Hong Wang
- Department of Biostatistics, Medstar Health Research Institute, Hyattsville, MD, USA
| | - Giuseppe Esposito
- Department of Nuclear Medicine, Georgetown University, Washington, DC, USA
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Jonklaas J. Nasal symptoms after radioiodine therapy: a rarely described side effect with similar frequency to lacrimal dysfunction. Thyroid 2014; 24:1806-14. [PMID: 25090584 PMCID: PMC4267770 DOI: 10.1089/thy.2014.0162] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Salivary and lacrimal side effects of radioiodine therapy have been carefully described. However, nasal side effects are rarely described. The objective of this study was to document the frequency of nasal side effects in comparison to the already well-documented lacrimal side effects and to determine contributing risk factors. METHODS A retrospective review of the medical records of 807 patients with differentiated thyroid cancer who received care at an academic medical center was conducted. Four hundred eleven patients who received treatment with radioactive iodine (RAI) were identified and included in the analysis. The frequency of both nasal and lacrimal side effects was ascertained. Factors that may have contributed to patients sustaining nasal damage after RAI therapy were also documented. These factors included radioactive iodine dose, method of preparation for receiving RAI therapy, and patient characteristics. RESULTS The mean dose of RAI administered was 109 mCi. Forty-three patients (10.5%) and 40 patients (9.7%) developed nasal and lacrimal side effects, respectively, following RAI treatment. The mean time of onset of nasal symptoms was 11 days, compared with 10 months for lacrimal symptoms. Radioiodine dose and body mass index were significantly positively and negatively correlated, respectively, with sustaining nasal side effects (p values of 0.04 and 0.01, respectively). Similarly, both RAI dose and body mass index were significantly correlated, positively and negatively, respectively, with sustaining lacrimal side effects (p values of 0.02 and 0.01). Preparation for treatment using a withdrawal protocol was associated with increased risk of both nasal and lacrimal side effects, compared with a recombinant human thyrotropin (rhTSH) protocol (p values of <0.01 and 0.01). The odds ratios (95% confidence interval [CI]) for nasal and lacrimal side effects with recombinant rhTSH preparation were 0.22 [0.11-0.44] and 0.37 [0.18-0.76], respectively. Instructions to maintain adequate hydration and development of lacrimal symptoms were only associated with nasal symptoms in unadjusted analyses. CONCLUSIONS Both nasal and lacrimal dysfunction occurred at an approximately 10% frequency. Although it cannot be determined whether acute nasal side effects are followed by long-term ramifications, these consequences of RAI could potentially add to the reasons to carefully evaluate the benefits and risks of RAI therapy on an individual basis.
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Mirzababaee M, Shafiei B, Seifollahi S, Motazdian M, Fatholahi L, Delavari S, Naghshine R, Baharfar N, Tabeie F, Javadi H, Assadi M, Asli IN. Management of gastrointestinal complaints in differentiated thyroid cancer patients treated with (131)I: comparison of the efficacy of pantoprazole, metoclopramide, and ondansetron - a randomized clinical trial. Nuklearmedizin 2014; 53:186-9. [PMID: 24961816 DOI: 10.3413/nukmed-0654-14-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare safety and efficacy of pantoprazol , metoclopramide, ondansetron, as compared to placebo, in controlling gastrointestinal (GI) complaints of thyroid cancer patients treated with I-131these patients. DESIGN Four-armed, parallel group, single blind, randomized controlled clinical trial, setting: A university hospital, registration: database for clinical trials IRCT2013061713705N1. PATIENTS 85 patients with differentiated thyroid cancer who received 131I. MAIN OUTCOME MEASURES Postradioiodine nausea and vomiting within three days of therapy (primary endpoint); occurrence of adverse reaction. RESULTS The patients' characteristics were similar within the study groups. Among the study variables, age, sex, administered dosage, history of previous GI complaints, and history of hyperemesis gravidarum in female patients were not statistically different among the groups (p > 0.05). The results revealed that only ondansetron shows a therapeutic benefit over the placebo in controlling nausea (p < 0.05); however, it does not prevent vomiting (p > 0.05). The other two drugs, pantoprazole and metoclopramide, did not control nausea (p > 0.05) or vomiting (p > 0.05). CONCLUSIONS This study may demonstrate that the therapeutic dose of ondansetron could be an effective prophylactic agent in controlling GI complaints in differential thyroid carcinoma (DTC) patients following RAI therapy; however, these preliminary findings should be validated in larger studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - M Assadi
- Majid Assadi, MD, The Persian Gulf Nuclear Medicine Research Center, University of Medical Sciences, Bushehr 3631, Iran, Tel. +98/771/258 01 69, Fax +98/771/254 18 28
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Esposito G. Initial radioiodine administration: when to use it and how to select the dose. Endocrinol Metab Clin North Am 2014; 43:385-400. [PMID: 24891168 DOI: 10.1016/j.ecl.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All published guidelines on the use of radioactive iodine for the treatment of well-differentiated thyroid cancer agree that an individualized assessment of the risk of cancer-related mortality and of disease recurrence should direct the decision of whether radioiodine treatment is needed and how much to administer. At the author's institution, they mostly follow the American Thyroid Association's risk stratification system, with the addition of a category of very-low-risk patients that do not receive radioactive iodine.
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Affiliation(s)
- Giuseppe Esposito
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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Sawka AM, Naeem A, Jones J, Lowe J, Segal P, Goguen J, Gilbert J, Zahedi A, Kelly C, Ezzat S. Persistent posttreatment fatigue in thyroid cancer survivors: a scoping review. Endocrinol Metab Clin North Am 2014; 43:475-94. [PMID: 24891173 DOI: 10.1016/j.ecl.2014.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The relevance of persistent posttreatment fatigue (PPF) to thyroid cancer (TC) survivor populations is not known. This article presents a scoping review, which is an overview of published research activity. Uncontrolled data suggest that PPF is one of the most common complaints in TC survivors. Furthermore, statistically significantly worse levels of fatigue were reported in TC survivors, compared with the general population or healthy controls. There was some inconsistency among PPF risk factors. More research is needed on PPF in TC survivors, including long-term prospective cohort studies, research on fatigue severity prevalence, and randomized controlled trials of treatment strategies.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network, 200 Elizabeth Street, 12th Floor, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada.
| | - Asima Naeem
- Division of Endocrinology, Department of Medicine, University Health Network, 200 Elizabeth Street, 12th Floor, Toronto, Ontario M5G 2C4, Canada
| | - Jennifer Jones
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Cancer Survivorship Program, Princess Margaret Hospital, University Health Network, 200 Elizabeth Street, Bcs-045, Toronto, Ontario M5G 2C4, Canada
| | - Julia Lowe
- Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, H Wing, Toronto, Ontario M4N 3M5, Canada
| | - Philip Segal
- Division of Endocrinology, Department of Medicine, University Health Network, 200 Elizabeth Street, 12th Floor, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Jeannette Goguen
- Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, St. Michael's Hospital, 61 Queen Street East, 6th Floor, Toronto, Ontario M5C 2T2, Canada
| | - Jeremy Gilbert
- Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, H Wing, Toronto, Ontario M4N 3M5, Canada
| | - Afshan Zahedi
- Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Division of Endocrinology, Department of Medicine, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Catherine Kelly
- Division of Endocrinology, Department of Medicine, University of Toronto, 200 Elizabeth Street, 12 EN-243, Toronto, Ontario M5G 2C4, Canada; Division of Endocrinology, Department of Medicine, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, 200 Elizabeth Street, 12NU-1200, Toronto, Ontario M5G 2C4, Canada
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Yoon HJ, Seok JH. Clinical Factors Associated with Quality of Life in Patients with Thyroid Cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.11106/jkta.2014.7.1.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Hyung-Jun Yoon
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
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Husson O, Nieuwlaat WA, Oranje WA, Haak HR, van de Poll-Franse LV, Mols F. Fatigue among short- and long-term thyroid cancer survivors: results from the population-based PROFILES registry. Thyroid 2013; 23:1247-55. [PMID: 23578315 PMCID: PMC3783928 DOI: 10.1089/thy.2013.0015] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aims of this study were (i) to obtain insight into the prevalence of fatigue among short- and long-term thyroid cancer (TC) survivors, by comparing a sample of TC survivors with an age- and sex-matched normative population, and (ii) to investigate which demographic, clinical, and TC-specific health-related quality of life (HRQoL) characteristics were associated with fatigue. METHODS All patients found to have TC between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a cross-sectional survey on fatigue (Fatigue Assessment Scale), TC-specific HRQoL (THYCA-QoL), and psychological distress (Hospital Anxiety and Depression Scale). The fatigue scores were compared with those of an age- and sex-matched normative population (n=530). Multiple logistic regression analyses were conducted to investigate the independent associations between clinical and demographic characteristics, TC-specific HRQoL, and psychological distress with fatigue. RESULTS Eighty-six percent (n=306) responded. TC survivors were more often classified as fatigued or very fatigued (short-term <5 years: 43%; long-term 5-10 years: 44%; long-term 10-15 years: 47%; long-term >15 years: 39%) compared to the normative population (25%; p<0.001). Anxiety (odds ratio (OR) 1.15, 95% confidence interval [CI] 1.03-1.28) and depression (OR 1.43 [CI 1.22-1.68]) were associated with fatigue, as was also the case for TC-specific neuromuscular (OR 1.03 [CI 1.01-1.06]), concentration (OR 1.03 [CI 1.01-1.06]), and psychological TC-specific HRQoL (OR 1.06 [CI 1.02-1.10]). CONCLUSION Short- and long-term TC survivors report higher levels of fatigue than an age- and sex-matched normative population do. Both TC-specific HRQoL and psychological distress were associated with fatigue.
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Affiliation(s)
- Olga Husson
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | | | - Wilma A. Oranje
- Department of Endocrinology, TweeSteden Hospital, Tilburg, The Netherlands
| | - Harm R. Haak
- Department of Endocrinology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Lonneke V. van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
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37
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Banach R, Bartès B, Farnell K, Rimmele H, Shey J, Singer S, Verburg FA, Luster M. Results of the Thyroid Cancer Alliance international patient/survivor survey: Psychosocial/informational support needs, treatment side effects and international differences in care. Hormones (Athens) 2013; 12:428-38. [PMID: 24121384 DOI: 10.1007/bf03401308] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To comprehensively assess the experience of a large, diverse cohort and identify potential care improvements, the Thyroid Cancer Alliance, an international patient/survivor group coalition, surveyed thyroid cancer patients/survivors worldwide. DESIGN English, German, French or Spanish versions of a self-developed 43-item questionnaire were completed, predominantly online, by 2398 respondents from the US (37.9%), Germany (21.3%), the UK (11.5%), Canada (11.4%), France (9%), and 35 other countries. Females and differentiated thyroid carcinoma patients each comprised ~87% of respondents. Diagnosis occurred at age 30-59 years in 71.8%, within <1 (1-5) year(s) before survey completion in 16.4% (55%). RESULTS At diagnosis, no psychological (or other professional) support was offered to 92.6% (76.9%) of respondents, no patient organization referral was made to 84.1%, and no clear written disease/treatment information was given to 63%. The five leading care improvement suggestions involved increased informational/psychosocial support. Among respondents undergoing neck surgery pre-survey completion (n = 2380), 72.5% reported at least transient complications, including hypocalcemia (38.8%), voice problems (36.2%), numbness (28.7%), or restricted neck/shoulder movement (27.6%). CONCLUSIONS This large, multinational, patient/survivor-initiated cross-sectional survey suggests that thyroid cancer patients/survivors have substantial unmet informational/psychosocial support needs and suffer frequent treatment morbidity; disease management and some patient/survivor experience differ appreciably among countries.
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Affiliation(s)
- Rita Banach
- Thyroid Cancer Canada/Cancer de la thyroϊde Canada, Toronto, Canada
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Husson O, Haak HR, Mols F, Nieuwenhuijzen GA, Nieuwlaat WA, Reemst PH, Huysmans DA, Toorians AW, van de Poll-Franse LV. Development of a disease-specific health-related quality of life questionnaire (THYCA-QoL) for thyroid cancer survivors. Acta Oncol 2013; 52:447-54. [PMID: 23013266 DOI: 10.3109/0284186x.2012.718445] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To date, no valid instrument is available that focuses on specific health-related quality of life (HRQoL) issues that affect thyroid cancer survivors. The objective of this study was to develop and pretest a thyroid cancer specific HRQoL questionnaire that can be used in addition to the more general European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). MATERIAL AND METHODS Potentially relevant issues were identified by a systematic literature review, a focus group meeting, and an issue list completed by six health care professionals (HCP) and 18 thyroid cancer survivors. Resultant issues were analyzed on importance and relevance (phase I). The issues were formulated into a long provisional list of questions (phase II). These questions were administered in combination with the EORTC QLQ-C30 to 306 Dutch thyroid cancer survivors to pretest the hypothesized scale structure (phase III). Although the development of this questionnaire was not set up as an international study, phases I-III are in agreement with the methodology of the EORTC guidelines. RESULTS The literature search, focus group and issue list completed by HCP and survivors resulted in 75 issues. These were reduced to create a 30 item provisional list. Pretesting led to a selection of 24 items with a good range of response. This resulted in the THYCA-QoL containing 24 items and seven conceptual scales. CONCLUSION The THYCA-QoL in combination with the EORTC QLQ-C30 is ready for a large (international) scale validation study, and will assess HRQoL issues of most relevance and concern for thyroid cancer survivors.
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Affiliation(s)
- Olga Husson
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology and Neuropsychology, Tilburg University, The Netherlands.
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Yoo SH, Choi-Kwon S. Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation. J Korean Acad Nurs 2013; 43:801-11. [DOI: 10.4040/jkan.2013.43.6.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seon Hee Yoo
- Nuclear Medicine Department, Asan Medical Center, Seoul, Korea
| | - Smi Choi-Kwon
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Gal TJ, Streeter M, Burris J, Kudrimoti M, Ain KB, Valentino J. Quality of life impact of external beam radiotherapy for advanced thyroid carcinoma. Thyroid 2013; 23:64-9. [PMID: 22971127 DOI: 10.1089/thy.2012.0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND External beam radiotherapy (XRT) has an established role in the management of recurrent or advanced well-differentiated thyroid carcinoma (WDTC). The goal of this study was to investigate the impact of this additional intervention on the quality of life (QOL) compared with total thyroidectomy (TT), with or without adjuvant radioactive iodine (RAI). METHODS A cross-sectional analysis using validated QOL instruments was performed. Patients receiving XRT between 1992 and 2008 for WDTC were identified and offered study participation. The Quality of Life Radiation Therapy Instrument and the Head and Neck Companion Module were administered retrospectively (N=13). For a comparison, patients previously treated with TT (N=11) alone as well as TT with postoperative RAI (N=11) for WDTC were also evaluated. RESULTS Thirty-four patients were included in the analysis. The XRT group reported significant decreases in chewing, swallowing, and appetite, and significant increase in pain, compared with both the RAI group and the TT group. Significant differences were reported for questions with regard to peace of mind, feeling discouraged, saliva, taste, ability to eat regular food, and concerns for the appearance of the neck in both RAI and XRT groups compared with TT patients. Subscale analysis of head and neck specific questions demonstrated significant overall differences for both RAI and XRT groups compared with thyroidectomy alone, with no differences observed between RAI and XRT groups in a direct comparison. CONCLUSIONS RAI therapy results in a measurable decrease in head and neck specific QOL measures compared with TT alone. The addition of XRT results in additional measurable morbidity secondary to pain and dysphagia.
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Affiliation(s)
- Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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Joseph LJ, Bhartiya US, Raut YS, Hawaldar RW, Nayak Y, Pawar YP, Jambhekar NA, Rajan M. Radioprotective Effect of Ocimum sanctum and Amifostine on the Salivary Gland of Rats After Therapeutic Radioiodine Exposure. Cancer Biother Radiopharm 2011; 26:737-43. [DOI: 10.1089/cbr.2011.1014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lebana J. Joseph
- Bio-Medical Group, Radiation Medicine Centre, Bhabha Atomic Research Centre, C/O Tata Memorial Hospital Annexe, Mumbai, India
| | - Uma S. Bhartiya
- Bio-Medical Group, Radiation Medicine Centre, Bhabha Atomic Research Centre, C/O Tata Memorial Hospital Annexe, Mumbai, India
| | - Yogita S. Raut
- Bio-Medical Group, Radiation Medicine Centre, Bhabha Atomic Research Centre, C/O Tata Memorial Hospital Annexe, Mumbai, India
| | | | - Yogendra Nayak
- Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India
| | - Yogita P. Pawar
- Bio-Medical Group, Radiation Medicine Centre, Bhabha Atomic Research Centre, C/O Tata Memorial Hospital Annexe, Mumbai, India
| | | | - M.G.R. Rajan
- Bio-Medical Group, Radiation Medicine Centre, Bhabha Atomic Research Centre, C/O Tata Memorial Hospital Annexe, Mumbai, India
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Husson O, Haak HR, Oranje WA, Mols F, Reemst PHM, van de Poll-Franse LV. Health-related quality of life among thyroid cancer survivors: a systematic review. Clin Endocrinol (Oxf) 2011; 75:544-54. [PMID: 21615448 DOI: 10.1111/j.1365-2265.2011.04114.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment and follow-up care procedures of thyroid cancer impose great challenges on survivors and could potentially affect their health-related quality of life (HRQoL). METHODS Two authors systematically reviewed the available literature on HRQoL of thyroid cancer survivors. A PubMed literature search for original articles published until February 2011 was performed. Twenty-seven articles, published between 1997 and 2010, which met the predefined inclusion criteria, were subjected to a quality checklist. RESULTS All selected studies, except one, were of adequate or good quality. Surgery had a negative impact on short-term HRQoL scores, but these scores returned to preoperational levels when time since surgery increased. Long-term thyroid hormone therapy (levothyroxine) can lead to abnormalities like hyperthyroidism. HRQoL was most affected during thyroid hormone withdrawal for radioiodine remnant ablation or follow-up procedures. The use of recombinant human thyroid stimulating hormone instead of hormone withdrawal leads to considerable improvements in HRQoL during follow-up testing. The results for (long-term) survivors were contradicting. While most (long-term) survivors report some specific long-lasting health problems, some studies found a lower HRQoL for thyroid cancer survivors compared with a healthy population or other reference groups, whereas other studies found similar HRQoL levels. CONCLUSION This review indicates that thyroid cancer survivors generally have a similar or slightly worse HRQoL compared with the normative population; however, they report some specific medical problems after cancer treatment and follow-up tests, which have a direct negative impact on their current HRQoL and could affect their long-term HRQoL. Specific longitudinal survivorship studies are lacking.
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Affiliation(s)
- Olga Husson
- Department of Medical Psychology and Neuropsychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
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Rastmanesh R. An urgent need to include risk-benefit analysis in clinical trials investigating conjugated linoleic acid supplements in cancer patients. Contemp Clin Trials 2010; 32:69-73. [PMID: 20851779 DOI: 10.1016/j.cct.2010.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/13/2010] [Accepted: 09/08/2010] [Indexed: 12/29/2022]
Abstract
Malnutrition and weight loss are common in patients with cancer, both factors could potentially affect the response and tolerance to treatment, decreased quality of life, and thus associate them with poor survival. Conjugated linoleic acid (CLA) is shown to have beneficial health effects in healthy and disease situations including chemoprotective properties in various experimental cancer models. However, the anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in the Netherlands Cohort Study on Diet and Cancer and a prospective cohort of Swedish women. Cancer patients are already at increased risk of anorexia and there are evidences that CLA suppresses appetite even in healthy individuals. Risk/benefit analysis of CLA supplementation has never been reported before and it is not clear whether any beneficial anti-tumor effect of CLA prevails over its anti-appetite and/or weight lowering side effect in these patients. I suggest that clinical trials investigating CLA supplements in cancer patients, measure appropriate variables such as food intake, weight, and appetite change to yield preliminary data for future trials. I also suggest that data from previous trials that have administered CLA supplements to cancer patients be re-analyzed retrospectively to attempt to find out any effect from routine nutritional measures such as weight, serum albumin and such as those.
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Affiliation(s)
- Reza Rastmanesh
- Department of Clinical Nutrition and Dietetics, Shahid Beheshti University of Medical Sciences, National Nutrition and Food Technology Research Institute, Arghavene Gharbi, Farahzadi Blvd, Shahrake Gharb, PO Box 19395-4741, Tehran, Iran.
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Klubo-Gwiezdzinska J, Van Nostrand D, Burman KD, Vasko V, Chia S, Deng T, Kulkarni K, Wartofsky L. Salivary gland malignancy and radioiodine therapy for thyroid cancer. Thyroid 2010; 20:647-51. [PMID: 20470209 DOI: 10.1089/thy.2009.0466] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The risk of second primary malignancies in patients with well-differentiated thyroid cancer is of special interest because of the common use of radioactive iodine (RAI) ablation and/or treatment of these patients and the theoretical risk of subsequent nonthyroid malignancies associated with the radiation exposure. This brief report focuses specifically on the occurrence of second primary malignancies of the salivary glands. RAI residency within salivary tissues is known to have both acute and chronic consequences on salivary function, but secondary neoplasia is quite unusual. SUMMARY We present a very rare case of a patient with papillary thyroid cancer treated with 600 mCi of RAI, who subsequently developed salivary gland cancer. CONCLUSIONS We recommend salivary gland protection to diminish potential side effects after the exposure to radioiodine. On the basis of our experience we suggest administration of sialogogues (such as lemon juice) continuously, every 30-60 minutes for 24 hours, after RAI administration.
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Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NNF, Mello ALS, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18:1039-60. [PMID: 20237805 DOI: 10.1007/s00520-010-0827-8] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 01/26/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.
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Affiliation(s)
- S B Jensen
- Department of Oral Medicine, University of Copenhagen, Copenhagen, Denmark.
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Abstract
The incidence of thyroid cancer in young adults is rising. Differentiated carcinoma (ie, papillary, follicular, and their variants) and medullary thyroid carcinoma (MTC) represent the two most common subtypes, with differing etiologies, prognoses, and management strategies. Ultrasound (US)-guided fine needle aspiration (FNA) is the best initial test for evaluating a nodule or mass suspicious for malignancy. Tumor histology, in addition to radiographic findings and clinical presentation, guides surgical management, the need for adjuvant therapies, and the optimal approach to long-term follow-up. Radioactive iodine (RAI) is used to reduce recurrence and improve survival for differentiated thyroid carcinomas (DTCs). Emerging systemic therapies provide options for patients with progressive metastatic MTC or radio-resistant DTC. Overall, the prognosis for the most common thyroid malignancy, papillary thyroid carcinoma (PTC), is excellent. The treatment of young adult thyroid cancer patients occurs optimally as part of a multidisciplinary coordination of care.
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Affiliation(s)
- Anita K Ying
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Hirsch D, Ginat M, Levy S, Benbassat C, Weinstein R, Tsvetov G, Singer J, Shraga-Slutzky I, Grozinski-Glasberg S, Mansiterski Y, Shimon I, Reicher-Atir R. Illness perception in patients with differentiated epithelial cell thyroid cancer. Thyroid 2009; 19:459-65. [PMID: 19415995 DOI: 10.1089/thy.2008.0360] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with differentiated thyroid cancer (DTC) usually have a good prognosis but may experience a decline in quality of life (QOL). The way patients perceive their illness may have a major impact on their QOL. Our hypothesis was that patients with DTC frequently perceive their illness as much more severe than its objective clinical characteristics indicate. The aim of the study was to investigate how patients with DTC perceive their illness and to correlate these findings to various demographic parameters as well as objective indices of disease severity. METHODS The self-administered Illness Perception Questionnaire-Revised (IPQ-R) was completed by consecutive patients with DTC during routine follow-up at the endocrine clinic. The questionnaire consists of three parts that measure different aspects of illness perception. The patients' medical records were reviewed for data on demographic parameters (sex, age) and indices of disease severity (duration of DTC, disease stage at diagnosis, number of operations, number of radioactive iodine treatments, and evidence of disease persistence/recurrence). The patients were also asked for additional data on family status, level of education, and employment status. Pearson and Spearman correlations and analysis of variance were used for statistical analysis. RESULTS The study group included 110 patients (91 women) of mean age 53.5 years. Level of education was the only demographic factor found to affect the patients' perception of their illness. There was no correlation of patient illness perception and cancer stage. Among the disease-severity parameters, time since last treatment, evidence of disease persistence, and number of iodine treatments were significantly associated with a negative disease perception. Number of iodine treatments was the most broadly affecting factor. There was a high correlation of scores among the various illness perception subscales. CONCLUSIONS Patients with DTC perceive their illness on a subjective, emotional basis unrelated to its actual severity. To improve patients' illness representations and, consequently, their QOL, a trained psychologist should be included in the multidisciplinary team that manages patients with DTC. Attention should be particularly directed to less-educated patients and patients who require repeated iodine treatments.
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Affiliation(s)
- Dania Hirsch
- Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
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Tan LGL, Nan L, Thumboo J, Sundram F, Tan LKS. Health-related quality of life in thyroid cancer survivors. Laryngoscope 2007; 117:507-10. [PMID: 17334313 DOI: 10.1097/mlg.0b013e31802e3739] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study objective was to study the impact of the diagnosis, treatment, and follow-up of differentiated thyroid cancer (DTC) on the quality of life and related issues in an urban multi-ethnic Asian population. DESIGN A self-administered questionnaire containing the Short Form 36 Health Survey (SF-36) and assessing sociodemographic, disease, and treatment-related status was mailed to patients with DTC. MAIN OUTCOMES One hundred fifty-two (52.4%) of 290 patients answered the questionnaire. There was a statistically significant decrease in SF-36 scores between thyroid cancer survivors and the general population in all domains except for social functioning (SF). Physical functioning (PF) was worse in those survivors who were aged 50 years or older. Mental health (MH) scores were better in those who had more than 12 years of formal education. Being employed had a positive influence on role physical (RP) and role emotional (RE) scores. Being of Malay/Indian ethnicity strongly correlated with lower scores in bodily pain (BP), SF, RE and MH domains. CONCLUSION Although most patients with well-differentiated thyroid cancer have near normal life expectancy, our study has shown that there is a significant decrease in their quality of life, especially in the elderly and poorer educated. Returning to work should be encouraged to improve the quality of life in DTC survivors.
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Affiliation(s)
- Lincoln G L Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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