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O'Neill CJ, Carlson MA, Rowe CW, Fradgley EA, Paul C. Hearing the Voices of Australian Thyroid Cancer Survivors: Qualitative Thematic Analysis of Semistructured Interviews Identifies Unmet Support Needs. Thyroid 2023; 33:1455-1464. [PMID: 37335225 PMCID: PMC10734898 DOI: 10.1089/thy.2023.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: Most thyroid cancer survivors regain their physical health-related quality of life, but psychological and social deficits persist. The nature of these detriments remains poorly understood and they are insufficiently captured by survey data alone. To address this, qualitative data exploring the breadth and depth of thyroid cancer survivors' experiences and priorities for supportive care are required. Methods: Twenty semistructured interviews were undertaken with a purposive, maximum variation sample of thyroid cancer survivors. Interviews were transcribed verbatim and coded independently by two researchers. A hybrid model of inductive and realistic codebook analysis was undertaken with themes developed. Results: Patient experiences centered around three themes: (1) impact of diagnosis and treatment, (2) thyroid cancer does not happen in isolation, and (3) role of clinicians and formalized support structures. The word "cancer" had negative connotations, but for many, the reality of their experience was more positive. Despite feeling "lucky" at the relative low-risk nature of thyroid cancer, many patients reported fatigue, weight gain, and difficulty returning to usual activities; concerns that were largely dismissed or minimized by clinicians. Few were offered any support beyond their treating doctors; where patients attempted to access formalized supportive care, little was available or appropriate. Life stage and concurrent family and social stressors greatly impacted patients' ability to cope with diagnosis and treatment. Addressing thyroid cancer in isolation felt inappropriate without appreciating the broader context of their lives. Interactions with clinicians were largely positive, particularly where information was communicated as a means of empowering patients to participate in shared decision-making and where clinicians "checked in" emotionally with patients. Information about initial treatments was largely adequate but information on longer term effects and follow-up was lacking. Many patients felt that clinicians focused on physical well-being and scan results, missing opportunities to provide psychological support. Conclusions: Thyroid cancer survivors can struggle to navigate their cancer journey, particularly with regard to psychological and social functioning. There is a need to acknowledge these impacts at the time of clinical encounters, as well as develop information resources and support structures that can be individualized to optimize holistic well-being for those in need.
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Affiliation(s)
- Christine J. O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Melissa A. Carlson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christopher W. Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Elizabeth A. Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Yang W, Lee YK, Lorgelly P, Rogers SN, Kim D. Challenges of Shared Decision-making by Clinicians and Patients With Low-risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Ethnography. JAMA Otolaryngol Head Neck Surg 2023; 149:452-459. [PMID: 36951823 DOI: 10.1001/jamaoto.2023.0101] [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: 03/24/2023]
Abstract
Importance Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient's values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise. Objectives To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC. Evidence Review This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis. Findings Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked. Conclusions and Relevance The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC. Trial Registration PROSPERO Identifier: CRD42022286395.
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Affiliation(s)
- Wanding Yang
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Ying Ki Lee
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
| | - Paula Lorgelly
- Faculty of Medical and Health Sciences and School of Business, University of Auckland, Auckland, New Zealand
| | - Simon N Rogers
- Department of Oral and Maxillofacial Surgery, Wirral University Teaching Hospital, Birkenhead, UK
- Faculty of Health, Social Care and Medicine, Edge Hill University, Liverpool, UK
| | - Dae Kim
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
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3
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Monzani ML, Piccinini F, Boselli G, Corleto R, Margiotta G, Peeters RP, Simoni M, Brigante G. Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine. J Endocrinol Invest 2023; 46:319-326. [PMID: 35988109 DOI: 10.1007/s40618-022-01903-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Previous studies demonstrated decreased quality of life (QoL) in differentiated thyroid cancer (DTC) survivors and suggested QoL variability related to time from thyroidectomy and levothyroxine dosage. The aims of this study were to evaluate QoL in thyroidectomized subjects in different levothyroxine states and to evaluate the association between TSH and thyroid hormones and QoL. METHODS Prospective 5-year study enrolling 208 patients thyroidectomized for DTC, studied in one to four times according to levothyroxine dosage: withdrawal (WITHD), complete (C-SUPP) and mild TSH-suppression (M-SUPP), replacement (REPL). Each patient was allowed to participate into the study more than one time. A total of 300 evaluations were collected, consisting of detailed thyroid hormone profile and QoL assessment through the ThyPRO questionnaire. RESULTS Comparing the four groups, significant differences were found for anxiety, impaired social and daily life and item 12 (overall impact of thyroid disease) domains (p < 0.05). Interestingly, C-SUPP subjects reported the best scores in almost all ThyPRO scales. Significant correlations were found between QoL and pituitary-thyroid axis function, as well as between QoL and gender, being females more affected. At multiple regression analyses fT3 demonstrated to be the best explanatory factor for overall impact of thyroid disease on the patient's life, followed by gender. CONCLUSIONS TSH-suppressive doses of levothyroxine are more effective in improving QoL in DTC patients after thyroidectomy. These results confirm the urgent need of further studies aimed to define the best treatment of hypothyroidism, effective on well-being and harmless for patients.
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Affiliation(s)
- M L Monzani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - F Piccinini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Boselli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - R Corleto
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Margiotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - R P Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Brigante
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy.
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Ullmann TM, Papaleontiou M, Sosa JA. Current Controversies in Low-Risk Differentiated Thyroid Cancer: Reducing Overtreatment in an Era of Overdiagnosis. J Clin Endocrinol Metab 2023; 108:271-280. [PMID: 36327392 PMCID: PMC10091361 DOI: 10.1210/clinem/dgac646] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Low-risk differentiated thyroid cancer (DTC) is overdiagnosed, but true incidence has increased as well. Owing to its excellent prognosis with low morbidity and mortality, balancing treatment risks with risks of disease progression can be challenging, leading to several areas of controversy. EVIDENCE ACQUISITION This mini-review is an overview of controversies and difficult decisions around the management of all stages of low-risk DTC, from diagnosis through treatment and follow-up. In particular, overdiagnosis, active surveillance vs surgery, extent of surgery, radioactive iodine (RAI) treatment, thyrotropin suppression, and postoperative surveillance are discussed. EVIDENCE SYNTHESIS Recommendations regarding the diagnosis of DTC, the extent of treatment for low-risk DTC patients, and the intensity of posttreatment follow-up have all changed substantially in the past decade. While overdiagnosis remains a problem, there has been a true increase in incidence as well. Treatment options range from active surveillance of small tumors to total thyroidectomy followed by RAI in select cases. Recommendations for long-term surveillance frequency and duration are similarly broad. CONCLUSION Clinicians and patients must approach each case in a personalized and nuanced fashion to select the appropriate extent of treatment on an individual basis. In areas of evidential equipoise, data regarding patient-centered outcomes may help guide decision-making.
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Affiliation(s)
- Timothy M Ullmann
- Division of General Surgery, Department of Surgery, Albany Medical College, 50 New Scotland Ave., MC-193, Albany, NY 12208, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 453S, Ann Arbor, MI 48109, USA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave. Ste. S320, Box 0104, San Francisco, CA 94143, USA
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Pitt SC, Zanocco K, Sturgeon C. The Patient Experience of Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:761-780. [PMID: 36244692 DOI: 10.1016/j.ecl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 3 phases of thyroid cancer care are discussed: diagnosis, management, and survivorship. Drivers of quality of life (QOL) in each phase are described, and suggestions are made for mitigating the risk of poor QOL. Active surveillance is another emerging management strategy that has the potential to improve QOL by eliminating upfront surgical morbidity but will need to be studied prospectively.
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Affiliation(s)
- Susan C Pitt
- Department of Surgery, University of Michigan Taubman 2920F, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kyle Zanocco
- Department of Surgery, University of California Los Angeles, CHS 72-222, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern University, 676 North Saint Claire Street, Suite 650, Chicago, IL 60611, USA.
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6
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Abstract
PURPOSE OF REVIEW This review describes the current state of the literature on patients' perceptions of receiving a diagnosis of thyroid cancer. The evaluation progresses from people's understanding about thyroid cancer in general to the lived experiences of those receiving an initial diagnosis or one of recurrence. The implications on patients' quality of life and treatment decisions are also discussed. RECENT FINDINGS Receiving a diagnosis of thyroid cancer often elicits intense and immediate emotions of shock and fear evoked by the word 'cancer,' which may be related to lack of knowledge about thyroid cancer specifically. Describing thyroid cancer as the 'good cancer' in an attempt to reassure patients is not necessarily reassuring and can inadvertently minimize the impact of a patient's diagnosis. Fear and worry about cancer in general and the possibility for recurrence contribute to lasting psychological distress and decreased quality of life. Patients' perceptions of their diagnosis and resulting emotional reactions influence treatment decision-making and have the potential to contribute to decisions that may over-treat a low-risk thyroid cancer. SUMMARY Understanding patients' experience of receiving a thyroid cancer diagnosis is critical because their emotional reactions can have a profound impact on treatment decision-making and quality of life.
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Affiliation(s)
- Catherine B. Jensen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Susan C. Pitt
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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7
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Thandrayen J, Joshy G, Stubbs J, Bailey L, Butow P, Koczwara B, Laidsaar-Powell R, Rankin NM, Beckwith K, Soga K, Yazidjoglou A, Bin Sayeed MS, Canfell K, Banks E. Workforce participation in relation to cancer diagnosis, type and stage: Australian population-based study of 163,556 middle-aged people. J Cancer Surviv 2021; 16:461-473. [PMID: 34008147 PMCID: PMC8964624 DOI: 10.1007/s11764-021-01041-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To quantify the relationship of cancer diagnosis to workforce participation in Australia, according to cancer type, clinical features and personal characteristics. METHODS Questionnaire data (2006-2009) from participants aged 45-64 years (n=163,556) from the population-based 45 and Up Study (n=267,153) in New South Wales, Australia, were linked to cancer registrations to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for non-participation in the paid workforce-in participants with cancer (n=8,333) versus without (n=155,223), for 13 cancer types. RESULTS Overall, 42% of cancer survivors and 29% of people without cancer were out of the workforce (PR=1.18; 95%CI=1.15-1.21). Workforce non-participation varied substantively by cancer type, being greatest for multiple myeloma (1.83; 1.53-2.18), oesophageal (1.70; 1.13-2.58) and lung cancer (1.68; 1.45-1.93) and moderate for colorectal (1.23; 1.15-1.33), breast (1.11; 1.06-1.16) and prostate cancer (1.06; 0.99-1.13). Long-term survivors, 5 or more years post-diagnosis, had 12% (7-16%) greater non-participation than people without cancer, and non-participation was greater with recent diagnosis, treatment or advanced stage. Physical disability contributed substantively to reduced workforce participation, regardless of cancer diagnosis. CONCLUSIONS Cancer survivors aged 45-64 continue to participate in the workforce. However, participation is lower than in people without cancer, varying by cancer type, and is reduced particularly around the time of diagnosis and treatment and with advanced disease. IMPLICATIONS FOR CANCER SURVIVORS While many cancer survivors continue with paid work, participation is reduced. Workforce retention support should be tailored to survivor preferences, cancer type and cancer journey stage.
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Affiliation(s)
- Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Stubbs
- CanSpeak, Sydney, New South Wales, Australia
| | - Louise Bailey
- Primary Care Collaborative Cancer Clinical Trials Group Community Advisory Group, Melbourne, Victoria, Australia
- Psycho-oncology Cooperative Research Group Community Advisory Group, Camperdown, New South Wales, Australia
| | - Phyllis Butow
- The University of Sydney, Sydney, New South Wales, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Nicole M Rankin
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katie Beckwith
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kay Soga
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Muhammad Shahdaat Bin Sayeed
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Sax Institute, Glebe, New South Wales, Australia
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8
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Lubitz CC, Kiernan CM, Toumi A, Zhan T, Roth MY, Sosa JA, Tuttle RM, Grubbs EG. Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer. Endocr Pract 2021; 27:383-389. [PMID: 33840638 PMCID: PMC10028733 DOI: 10.1016/j.eprac.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). METHODS An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. RESULTS Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. CONCLUSION Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.
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Affiliation(s)
- Carrie C Lubitz
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, Tennessee
| | - Asmae Toumi
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts
| | - Tiannan Zhan
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts
| | - Mara Y Roth
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Julie A Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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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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10
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Büttner M, Hinz A, Singer S, Musholt TJ. Quality of life of patients more than 1 year after surgery for thyroid cancer. Hormones (Athens) 2020; 19:233-243. [PMID: 32201929 DOI: 10.1007/s42000-020-00186-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with thyroid cancer are often assumed to have no quality of life (QOL) impairments after treatment because of thyroid cancer's good prognosis. However, the QOL implications of surgical complications and the necessity to take lifelong medication are seldom assessed. METHODS Patients who had surgery due to thyroid cancer at the University Medical Center Mainz between 2010 and 2015 and who had calcium or parathyroid hormone levels below the reference values immediately following surgery were eligible for this study. QOL was assessed using the EORTC QLQ-C30 and the thyroid cancer module EORTC QLQ-THY34. Multiple logistic regression was used to determine factors associated with a worse QOL compared with a general population. RESULTS A total of 75 (56%) of 134 eligible patients participated in the study. Patients with persistent/prolonged calcium or vitamin D intake reported worse QOL in the domains of global health, physical functioning, role functioning, emotional functioning, and insomnia than patients without current intake. Current calcium and vitamin D intake, higher education, living with a partner, and age had an effect on the odds of having worse QOL than the age- and sex-adjusted general population. CONCLUSION Prolonged calcium and/or vitamin D intake are negatively associated with certain domains of QOL in thyroid cancer patients who are at least 1 year post surgery. Assessment of calcium and vitamin D and diagnosis of hypoparathyroidism are therefore important for the follow-up of thyroid cancer survivors since it may affect their QOL.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany.
- University Cancer Centre, Mainz, Germany.
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Thomas J Musholt
- University Cancer Centre, Mainz, Germany
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany
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11
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Wallner LP, Reyes-Gastelum D, Hamilton AS, Ward KC, Hawley ST, Haymart MR. Patient-Perceived Lack of Choice in Receipt of Radioactive Iodine for Treatment of Differentiated Thyroid Cancer. J Clin Oncol 2019; 37:2152-2161. [PMID: 31283406 PMCID: PMC6698919 DOI: 10.1200/jco.18.02228] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE For many patients with differentiated thyroid cancer, use of radioactive iodine (RAI) does not improve survival or reduce recurrence risk. Yet there is wide variation in RAI use, emphasizing the importance of understanding patient perspectives regarding RAI decision making. PATIENTS AND METHODS All eligible patients diagnosed with thyroid cancer from 2014 to 2015 from the Georgia and Los Angeles SEER registries were surveyed (N = 2,632; response rate, 63%). Patients in whom selective RAI use is recommended were included in this analysis (n = 1,319). Patients were asked whether they felt like they had a choice to receive RAI (yes or no), how strongly their physician recommended RAI (5-point Likert-type scale), whether they received RAI (yes or no), and how satisfied they were with their RAI decision (more [score of 4 or greater] v less). Multivariable, weighted logistic regression with multiple imputation was used to assess the associations between patient characteristics and perception of no RAI choice and between perception of no RAI choice with receipt of RAI and decision satisfaction. RESULTS More than half of respondents (55.8%) perceived they did not have an RAI choice, and the majority of patients (75.9%) received RAI. The odds of perceiving no RAI choice was greater among those whose physician strongly recommended RAI (adjusted odds ratio [OR], 1.56; 95% CI, 1.13 to 2.17). Patients who perceived they did not have an RAI choice were more likely to receive RAI (adjusted OR, 2.50; 95% CI, 1.64 to 3.82) and report lower decision satisfaction (adjusted OR, 2.31; 95% CI, 1.67 to 3.20). CONCLUSION Many patients did not feel they had a choice about whether to receive RAI. Patients who perceived they did not have a choice were more likely to receive RAI and report lower decision satisfaction, suggesting a need for more shared decision making to reduce overtreatment.
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Affiliation(s)
| | | | - Ann S. Hamilton
- University of Southern California Keck School of Medicine, Los Angeles, CA
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12
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Hedman C, Djärv T, Strang P, Lundgren CI. Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study. Thyroid 2018; 28:1609-1617. [PMID: 30244657 DOI: 10.1089/thy.2018.0388] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence and need for lifelong follow-up. The aim was to study changes in health-related quality of life (HRQoL) from diagnosis to one year of follow-up. METHODS In this prospective population-based study, patients were identified from all the Swedish departments of oncology treating DTC. In total, 487 patients diagnosed with DTC between 2012 and 2017 were invited to answer the Swedish version of the Short Form-36 Health Survey (SF-36) and a study-specific questionnaire at diagnosis and after one year. RESULTS In total, 349 (72%) patients responded. Of these, 235 (67%) had reached one year of follow-up and also answered the questionnaire after one year. Of those, 23% had a negative view of life, and 75% had a fear of recurrence at diagnosis. These patients had a significantly lower HRQoL on eight and five of the SF-36 domains, respectively (p < 0.05). A negative view of life and a fear of recurrence also affected HRQoL negatively after one year of follow-up, with a significantly lower HRQoL on seven SF-36 domains for those reporting a negative view of life or fear of recurrence often (p < 0.05). Thyrotropin suppression did not affect HRQoL negatively. In regression models, HRQoL at diagnosis was the most important predictive factor for HRQoL at the one-year follow-up. CONCLUSIONS Despite a good prognosis, HRQoL was substantially affected at the time of diagnosis, with some improvements after one year. As fear of recurrence and a negative view of life substantially affect HRQoL, these patients should be given additional attention.
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Affiliation(s)
- Christel Hedman
- 1 Department of Molecular Medicine and Surgery, Solna, Karolinska Institutet , Stockholm, Sweden
- 2 Stockholms Sjukhem Foundation's R&D Department , Stockholm, Sweden
| | - Therese Djärv
- 3 Department of Medicine, Solna, Karolinska Institutet , Stockholm, Sweden
- 4 Karolinska University Hospital , Stockholm, Sweden
| | - Peter Strang
- 2 Stockholms Sjukhem Foundation's R&D Department , Stockholm, Sweden
- 5 Department of Oncology-Pathology, and Solna, Karolinska Institutet , Stockholm, Sweden
| | - Catharina Ihre Lundgren
- 1 Department of Molecular Medicine and Surgery, Solna, Karolinska Institutet , Stockholm, Sweden
- 4 Karolinska University Hospital , Stockholm, Sweden
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13
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Henry M, Chang Y, Frenkiel S, Chartier G, Payne R, MacDonald C, Loiselle C, Black MJ, Mlynarek AM, Ehrler A, Rosberger Z, Tamilia M, Hier MP. Feelings of Disenfranchisement and Support Needs Among Patients With Thyroid Cancer. Oncol Nurs Forum 2018; 45:639-652. [PMID: 30118450 DOI: 10.1188/18.onf.639-652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To offer a better understanding of the experiences, preferences, and needs of patients with thyroid cancer. PARTICIPANTS & SETTING 17 patients with thyroid cancer receiving treatment at a university-affiliated hospital in Montreal, Québec, Canada. METHODOLOGIC APPROACH Interviews were conducted with patients, and descriptive phenomenology was used to explore patients' lived experience. FINDINGS Coping with uncertainty was a major theme that emerged from interviews, with some of the main concerns being difficult treatment decisions, long surgery wait times, and fears about surgical complications, potential metastases, and death. Study participants reported that without a nurse and an interprofessional team, they would be lost in a system they believed minimized their illness and offered few resources to support them in a time of crisis. IMPLICATIONS FOR NURSING Nurses must understand how the needs of individuals with thyroid cancer are often overlooked because of the good prognosis associated with the disease and should work to meet these information and support needs.
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14
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Christakis I, Dimas S, Kafetzis ID, Roukounakis N. Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment. Ann R Coll Surg Engl 2018; 100:357-365. [PMID: 29484944 PMCID: PMC5956592 DOI: 10.1308/rcsann.2018.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/surgery
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/diagnosis
- Carcinoma/epidemiology
- Carcinoma/surgery
- Carcinoma/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
- Female
- Humans
- Incidence
- Incidental Findings
- Male
- Middle Aged
- Neoplasm Invasiveness
- Practice Guidelines as Topic
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Young Adult
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Affiliation(s)
- I Christakis
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Dimas
- Department of Endocrine Surgery, Mediterraneo Hospital, Athens, Greece
| | - ID Kafetzis
- Department of Endocrine Surgery, Errikos Dunant Hospital Center, Athens, Greece
| | - N Roukounakis
- First Department of General Surgery and Transplantation, ‘Evangelismos‘ General Hospital, Athens, Greece
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15
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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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16
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Hedman C, Strang P, Djärv T, Widberg I, Lundgren CI. Anxiety and Fear of Recurrence Despite a Good Prognosis: An Interview Study with Differentiated Thyroid Cancer Patients. Thyroid 2017; 27:1417-1423. [PMID: 28874092 DOI: 10.1089/thy.2017.0346] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite a good prognosis, fear of recurrence is prevalent, even several years after a diagnosis of differentiated thyroid cancer (DTC). For this reason, the aim of this study was to make an in-depth exploration of anxiety, sources of anxiety, and protective strategies. METHODS In order to capture a broad description of the phenomenon, a purposeful, maximum variation sampling strategy regarding age, sex, stage of disease, educational level, and time since diagnosis was used. In total, 21 patients were included in the study. Semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed with a qualitative content analysis. RESULTS Patients with and without recurrences narrated a picture indicating anxiety related to their current situation; future risks and threats were central to this picture. However, they initially minimized or even denied having anxiety, but subsequently described it as a major problem at the end of the interviews. Anxiety was related to risk of recurrence and the risk of developing other cancers, but also to fears of a future situation where no further treatment options were available. Previous experiences of delayed investigations added to these fears. In order to cope, patients developed protective strategies in order to keep evasive and frightening thoughts away. Everyday life, distractions, and focusing on "the small things in life" were examples of such strategies. CONCLUSIONS Anxiety is a common, although partially hidden, problem in DTC survivors, as they tended to deny it early in the dialogues. As anxiety is clearly related to follow-up routines, these should therefore be revaluated.
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Affiliation(s)
- Christel Hedman
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
- 2 R&D Department, Stockholms Sjukhem Foundation , Stockholm, Sweden
| | - Peter Strang
- 2 R&D Department, Stockholms Sjukhem Foundation , Stockholm, Sweden
- 3 Department of Oncology-Pathology, Karolinska Institutet , Stockholm, Sweden
| | - Therese Djärv
- 4 Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Ida Widberg
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
- 5 Gustavsberg's Health Care Centre , Gustavsberg, Sweden
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17
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Haymart MR, Esfandiari NH, Stang MT, Sosa JA. Controversies in the Management of Low-Risk Differentiated Thyroid Cancer. Endocr Rev 2017; 38. [PMID: 28633444 PMCID: PMC5546880 DOI: 10.1210/er.2017-00067] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Controversy exists over optimal management of low-risk differentiated thyroid cancer. This controversy occurs in all aspects of management, including surgery, use of radioactive iodine for remnant ablation, thyroid hormone supplementation, and long-term surveillance. Limited and conflicting data, treatment paradigm shifts, and differences in physician perceptions contribute to the controversy. This lack of physician consensus results in wide variation in patient care, with some patients at risk for over- or undertreatment. To reduce patient harm and unnecessary worry, there is a need to design and implement studies to address current knowledge gaps.
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Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
| | - Julia Ann Sosa
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
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18
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Randle RW, Bushman NM, Orne J, Balentine CJ, Wendt E, Saucke M, Pitt SC, Macdonald CL, Connor NP, Sippel RS. Papillary Thyroid Cancer: The Good and Bad of the "Good Cancer". Thyroid 2017; 27:902-907. [PMID: 28510505 PMCID: PMC5561445 DOI: 10.1089/thy.2016.0632] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Papillary thyroid cancer is often described as the "good cancer" because of its treatability and relatively favorable survival rates. This study sought to characterize the thoughts of papillary thyroid cancer patients as they relate to having the "good cancer." METHODS This qualitative study included 31 papillary thyroid cancer patients enrolled in an ongoing randomized trial. Semi-structured interviews were conducted with participants at the preoperative visit and two weeks, six weeks, six months, and one year after thyroidectomy. Grounded theory was used, inductively coding the first 113 interview transcripts with NVivo 11. RESULTS The concept of thyroid cancer as "good cancer" emerged unprompted from 94% (n = 29) of participants, mostly concentrated around the time of diagnosis. Patients encountered this perception from healthcare providers, Internet research, friends, and preconceived ideas about other cancers. While patients generally appreciated optimism, this perspective also generated negative feelings. It eased the diagnosis of cancer but created confusion when individual experiences varied from expectations. Despite initially feeling reassured, participants described feeling the "good cancer" characterization invalidated their fears of having cancer. Thyroid cancer patients expressed that they did not want to hear that it's "only thyroid cancer" and that it's "no big deal," because "cancer is cancer," and it is significant. CONCLUSIONS Patients with papillary thyroid cancer commonly confront the perception that their malignancy is "good," but the favorable prognosis and treatability of the disease do not comprehensively represent their cancer fight. The "good cancer" perception is at the root of many mixed and confusing emotions. Clinicians emphasize optimistic outcomes, hoping to comfort, but they might inadvertently invalidate the impact thyroid cancer has on patients' lives.
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Affiliation(s)
- Reese W. Randle
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | - Norah M. Bushman
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | - Jason Orne
- Qualitative Health Research Consultants, Madison, Wisconsin
- Department of Sociology, Drexel University, Philadelphia, Pennsylvania
| | | | - Elizabeth Wendt
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | - Megan Saucke
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | - Susan C. Pitt
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | | | - Nadine P. Connor
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S. Sippel
- Department of General Surgery, University of Wisconsin, Madison, Wisconsin
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19
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BÃRBUŞ ELENA, PEŞTEAN CLAUDIU, LARG MARIAIULIA, PICIU DOINA. Quality of life in thyroid cancer patients: a literature review. CLUJUL MEDICAL (1957) 2017; 90:147-153. [PMID: 28559697 PMCID: PMC5433565 DOI: 10.15386/cjmed-703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/24/2016] [Accepted: 10/10/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Quality of life (QoL) has received increasing interest in the last years, especially in patients with cancer. This article aims to analyze a selection of medical research papers regarding the quality of life in patients with thyroid carcinoma. We overviewed the main QoL aspects derived from several studies and highlighted those less researched issues, which could represent a solid base for future clinical studies. METHOD We used an integrative selection method of medical literature, choosing mostly "free access" studies, as it was considered that they could be easily viewed, searched and researched including by patients. RESULTS After an integrative literature review, we selected 16 relevant studies. Patients with thyroid cancer have several factors influencing their QoL, with both physical and psychological impact. The decisive factors are the quality of the surgical act, radioiodine therapy, follow-up using rh-TSH vs. hormonal withdrawal, access to behavioral help and the relationship with their physician. CONCLUSION We must understand the emotional impact of the cancer diagnosis on the patient and we must collaborate in order to help the patient restore the psychosomatic balance and to recover the quality of life.
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Affiliation(s)
- ELENA BÃRBUŞ
- Nuclear Medicine Department, “Prof. Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania. Nuclear Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - CLAUDIU PEŞTEAN
- Nuclear Medicine Department, “Prof. Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania. Nuclear Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - MARIA IULIA LARG
- Nuclear Medicine Department, “Prof. Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania. Nuclear Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - DOINA PICIU
- Nuclear Medicine Department, “Prof. Dr. Ion Chiricuta” Institute of Oncology, Cluj-Napoca, Romania. Nuclear Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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20
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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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21
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Lee JC, Chang P, Grodski S, Yeung M, Johnson W, Serpell J. Temporal analysis of thyroid cancer management in a Melbourne tertiary centre. ANZ J Surg 2016; 89:38-42. [PMID: 27758032 DOI: 10.1111/ans.13792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/20/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The American Thyroid Association (ATA) management guidelines for thyroid cancer were revised in 2009. The aim of this study was to determine if management of thyroid cancer in our institution has changed in accordance with the introduction of the revised ATA guidelines (ATA2009 ), and to compare the characteristics and management of thyroid cancer in a Melbourne endocrine surgery unit over a 7-year period. METHODS All patients treated by the Monash University Endocrine Surgery Unit for thyroid cancer between 2007 and 2013 were divided into two groups - the pre-ATA2009 group (2007-2010) and the post-ATA2009 group (2011-2013). Comparisons were made of the demographics, cytology, pathology, surgical outcome and adjuvant therapy using t-test and chi-squared tests. RESULTS There were 333 patients in the pre-ATA2009 group and 342 patients in the post-ATA2009 group. Fewer non-diagnostic fine-needle aspiration cytology results were identified in the post-ATA2009 group (4% versus 0.9%; P = 0.01), while the rates of other fine-needle aspiration cytology categories were similar. There was a reduction in the use of radioactive iodine ablation in the post-ATA2009 group, both in the proportion of patients being treated (66% versus 48%; P < 0.001) and the dosages used (mean 96 mCi versus 80 mCi; P < 0.01), despite similar tumour size in both groups. CONCLUSION The key changes in practice thought to be attributable to the 2009 revised ATA guidelines were the reduction in the use and dosage of radioactive iodine in the management of differentiated thyroid cancer.
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Affiliation(s)
- James C Lee
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Paula Chang
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Meei Yeung
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - William Johnson
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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22
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Hyun YG, Alhashemi A, Fazelzad R, Goldberg AS, Goldstein DP, Sawka AM. A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer. Thyroid 2016; 26:1239-50. [PMID: 27350421 DOI: 10.1089/thy.2016.0039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patient education and psychosocial support to patients are important elements of comprehensive cancer care, but the needs of thyroid cancer survivors are not well understood. METHODS The published English-language quantitative literature on (i) unmet medical information and (ii) psychosocial support needs of thyroid cancer survivors was systematically reviewed. A librarian information specialist searched seven electronic databases and a hand search was conducted. Two reviewers independently screened citations from the electronic search and reviewed relevant full-text papers. There was consensus between reviewers on the included papers, and duplicate independent abstraction was performed. The results were summarized descriptively. RESULTS A total of 1984 unique electronic citations were screened, and 51 full-text studies were reviewed (three from the hand search). Seven cross-sectional, single-arm, survey studies were included, containing data from 6215 thyroid cancer survivor respondents. The respective study sizes ranged from 57 to 2398 subjects. All of the studies had some methodological limitations. Unmet information needs were variable relating to the disease, diagnostic tests, treatments, and co-ordination of medical care. There were relatively high unmet information needs related to aftercare (especially long-term effects of the disease or its treatment and its management) and psychosocial concerns (including practical and financial matters). Psychosocial support needs were incompletely met. Patient information on complementary and alternative medicine was very limited. CONCLUSIONS In conclusion, thyroid cancer survivors perceive many unmet information needs, and these needs extend to aftercare. Psychosocial information and supportive care needs may be insufficiently met in this population. More work is needed to improve knowledge translation and psychosocial support for thyroid cancer survivors.
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Affiliation(s)
- Yong Gyu Hyun
- 1 Department of Volunteer Resources, University Health Network, Toronto, Canada
| | - Ahmad Alhashemi
- 2 Clinical Endocrinology Fellowship, Division of Endocrinology, Department of Medicine, University of Toronto , Toronto, Canada
| | - Rouhi Fazelzad
- 3 University Health Network Library and Information Services , Princess Margaret Cancer Centre, Toronto, Canada
| | - Alyse S Goldberg
- 2 Clinical Endocrinology Fellowship, Division of Endocrinology, Department of Medicine, University of Toronto , Toronto, Canada
| | - David P Goldstein
- 4 Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto , Toronto, Canada
| | - Anna M Sawka
- 5 Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto , Toronto, Canada
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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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Germano CMR, Bonato D, Maion VH, Avó LRDSD, Melo DG, Fontanella BJB. Possíveis novos determinantes da qualidade de vida de pacientes com câncer de tireoide tratado: um estudo qualitativo. CIENCIA & SAUDE COLETIVA 2016; 21:2451-62. [DOI: 10.1590/1413-81232015218.18142015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 11/18/2015] [Indexed: 05/29/2023] Open
Abstract
Resumo Objetivou-se uma abordagem qualitativa de fatores que determinariam a qualidade de vida de pacientes com carcinoma papilífero de tireoide tratados. Foram feitas 16 entrevistas em profundidade com indivíduos de 18 a 45 anos sobre suas representações e experiências com esta enfermidade, seguidas por análise de conteúdo de enunciados. Os resultados contêm aspectos já previstos em questionários estruturados sobre qualidade de vida, mas outros estão parcialmente presumidos nesses questionários (manejo do conceito de etiologia da doença, a inserção “forçada” dos pacientes no universo conceitual médico, o medo do prognóstico e as mudanças “positivas” no estilo de vida). A interpretação desses resultados beneficiou-se de elaborações teóricas de desenvolvimento recente: as angústias sobre a experiência da doença parecem configurar-se, para os participantes, como um “risco moderno”, no contexto de uma “sociedade de riscos”. O desenvolvimento de questionários estruturados de qualidade de vida requer constantes estudos qualitativos que captem mudanças nos aspectos subjetivos do construto, dada a dinamicidade dos significados histórico-culturais e psicológicos do processo saúde-doença, constantemente influenciados por inovações tecnológicas e sucessivas interpretações epidemiológicas.
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Rosenthal MS, Angelos P, Bible K, Fassler CA, Finder S, Greene LW, Tulchinsky M. Informed consent for low-risk thyroid cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2015-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Significant barriers to informed consent surround the clinical management of adult patients with well-differentiated thyroid cancer. The literature reveals lack of disclosure surrounding clinical equipoise; confusing and conflicting terminology; and an insufficient number of prospective trials with proper ethical oversight. We provide guidance for valid consent to treatment in this population, and propose stipulative definitions for a variety of terms used in this context. Three critical areas are addressed: surgical management, radioactive iodine management and nonvalidated practice. Sound ethical frameworks for valid consent in patients with low-risk thyroid cancer include consent to observational (or ‘active surveillance’) research protocols, consent to nonvalidated practice and consent when there are opposing standards of care due to insufficient data and disagreement among the community of experts.
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Affiliation(s)
- M Sara Rosenthal
- Departments of Internal Medicine, Pediatrics & Behavioral Science, Program for Bioethics, University of Kentucky, Lexington, KY, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, MacLean Center for Clinical Medical Ethics, Chicago, IL, USA
| | | | | | - Stuart Finder
- Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Loren Wissner Greene
- Division of Endocrinology & ObGyn, and Associate Faculty, Department of Population Health, Division of Medical Ethics, New York University School of Medicine, New York, NY, USA
| | - Mark Tulchinsky
- Division of Nuclear Medicine, Department of Radiology, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
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Fordham BA, Kerr C, de Freitas HM, Lloyd AJ, Johnston K, Pelletier CL, Tremblay G, Forsythe A, McIver B, Cohen EEW. Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer. Patient Prefer Adherence 2015; 9:1561-72. [PMID: 26604709 PMCID: PMC4639528 DOI: 10.2147/ppa.s90425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The aim of this study was to elicit utilities for radioactive iodine-refractory differentiated thyroid cancer (RR-DTC) and evaluate the impact of treatment response and toxicities on quality of life. PATIENTS AND METHODS RR-DTC health states were developed based on data from a previous qualitative study and iterative review by clinical experts. Following piloting, health states underwent valuation by 100 members of the UK public during time trade-off interviews. Mean utilities and descriptive distribution statistics were calculated, and a logistic regression analysis was conducted. RESULTS The demographic characteristics of the study sample were generally reflective of the UK population. Clear differentiation in valuation between health states was observed. No response/stable disease had an adjusted utility value of 0.87, with a corresponding gain of +0.04 following a treatment response and a decline of -0.35 for disease progression. Adverse events were associated with utility decrements between -0.47 (grade III diarrhea) and -0.05 (grade I/II alopecia). CONCLUSION The trade-off interviews derived utility weights show clear differentiation between RR-DTC health states in response to treatment. The values reported in this study are suitable for cost-effectiveness evaluations for new treatments in RR-DTC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ezra EW Cohen
- University of California San Diego Moores Cancer Center, La Jolla, CA, USA
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Sawka AM, Straus S, Rodin G, Heus L, Brierley JD, Tsang RW, Rotstein L, Ezzat S, Segal P, Gafni A, Thorpe KE, Goldstein DP. Thyroid cancer patient perceptions of radioactive iodine treatment choice: Follow-up from a decision-aid randomized trial. Cancer 2015. [PMID: 26195199 PMCID: PMC4832354 DOI: 10.1002/cncr.29548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient decision aids (P-DAs) inform medical decision making, but longer term effects are unknown. This article describes extended follow-up from a thyroid cancer treatment P-DA trial. METHODS In this single-center, parallel-design randomized controlled trial conducted at a Canadian tertiary/quaternary care center, early-stage thyroid cancer patients from a P-DA trial were contacted 15 to 23 months after randomization/radioactive iodine (RAI) decision making to evaluate longer term outcomes. It was previously reported that the use of the computerized P-DA in thyroid cancer patients considering postsurgical RAI treatment significantly improved medical knowledge in comparison with usual care alone. The P-DA and control groups were compared for the following outcomes: feeling informed about the RAI treatment choice, decision satisfaction, decision regret, cancer-related worry, and physician trust. In a subgroup of 20 participants, in-depth interviews were conducted for a qualitative analysis. RESULTS Ninety-five percent (70 of 74) of the original population enrolled in follow-up at a mean of 17.1 months after randomization. P-DA users perceived themselves to be significantly more 1) informed about the treatment choice (P = .008), 2) aware of options (P = .009), 3) knowledgeable about treatment benefits (P = .020), and 4) knowledgeable about treatment risks/side effects (P = .001) in comparison with controls. There were no significant group differences in decision satisfaction (P = .142), decision regret (P = .199), cancer-related worry (P = .645), mood (P = .211), or physician trust (P = .764). In the qualitative analysis, the P-DA was perceived to have increased patient knowledge and confidence in decision making. CONCLUSIONS The P-DA improved cancer survivors' actual and long-term perceived medical knowledge with no adverse effects. More research on the long-term outcomes of P-DA use is needed.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Sharon Straus
- Department of Medicine, St. Michael's Hospital/University of Toronto, Toronto, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Lineke Heus
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - James D Brierley
- Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Lorne Rotstein
- Department of Surgery, University Health Network/University of Toronto, Toronto, Canada
| | - Shereen Ezzat
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Phillip Segal
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto/Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network/University of Toronto, Toronto, Canada
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Sawka AM, Straus S, Rodin G, Tsang RW, Brierley JD, Rotstein L, Segal P, Gafni A, Ezzat S, Goldstein DP. Exploring the relationship between patients' information preference style and knowledge acquisition process in a computerized patient decision aid randomized controlled trial. BMC Med Inform Decis Mak 2015; 15:48. [PMID: 26088605 PMCID: PMC4474358 DOI: 10.1186/s12911-015-0168-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 05/26/2015] [Indexed: 11/22/2022] Open
Abstract
Background We have shown in a randomized controlled trial that a computerized patient decision aid (P-DA) improves medical knowledge and reduces decisional conflict, in early stage papillary thyroid cancer patients considering adjuvant radioactive iodine treatment. Our objectives were to examine the relationship between participants’ baseline information preference style and the following: 1) quantity of detailed information obtained within the P-DA, and 2) medical knowledge. Methods We randomized participants to exposure to a one-time viewing of a computerized P-DA (with usual care) or usual care alone. In pre-planned secondary analyses, we examined the relationship between information preference style (Miller Behavioural Style Scale, including respective monitoring [information seeking preference] and blunting [information avoidance preference] subscale scores) and the following: 1) the quantity of detailed information obtained from the P-DA (number of supplemental information clicks), and 2) medical knowledge. Spearman correlation values were calculated to quantify relationships, in the entire study population and respective study arms. Results In the 37 P-DA users, high monitoring information preference was moderately positively correlated with higher frequency of detailed information acquisition in the P-DA (r = 0.414, p = 0.011). The monitoring subscale score weakly correlated with increased medical knowledge in the entire study population (r = 0.268, p = 0.021, N = 74), but not in the respective study arms. There were no significant associations with the blunting subscale score. Conclusions Individual variability in information preferences may affect the process of information acquisition from computerized P-DA’s. More research is needed to understand how individual information preferences may impact medical knowledge acquisition and decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0168-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Toronto General Hospital, 200 Elizabeth Street, 12 EN-212, Toronto, ON, M5G 2C4, Canada.
| | - Sharon Straus
- Department of Medicine, St. Michael's Hospital, 30 Bond Street, Shuter 2-026, Toronto, ON, M5B 1W8, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, M5B 1W8, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology, Princess Margaret Hospital, University Health Network, 16th Floor Room 724, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Department of Psychiatry and Palliative Care, Princess Margaret Hospital, University of Toronto, 16th Floor Room 724, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, 5th Floor Room 963, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - James D Brierley
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, 5th Floor Room 963, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Lorne Rotstein
- Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 10 EN-220, Toronto, ON, M5G 2C4, Canada.,Toronto General Hospital, University of Toronto, 200 Elizabeth Street, 10 EN-220, Toronto, ON, M5G 2C4, Canada
| | - Phillip Segal
- Division of Endocrinology, Department of Medicine, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 12 EN-216, Toronto, ON, M5G 2C4, Canada.,Toronto General Hospital, University of Toronto, 200 Elizabeth Street, 12 EN-216, Toronto, ON, M5G 2C4, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-208, Hamilton, ON, L8S 4K1, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, University Health Network, Toronto General Hospital, Endocrine Oncology 585 University Avenue, 9NU-986, Toronto, ON, M5G 2N2, Canada
| | - David P Goldstein
- Department of Otolaryngology Head and Neck Surgery, Wharton Head and Neck Centre, University Health Network, 3-952, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Wharton Head and Neck Centre, University of Toronto, 3-952, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Gamper EM, Sztankay M. Lebensqualität und psychische Belastungen von Schilddrüsenkrebspatienten. ONKOLOGE 2015. [DOI: 10.1007/s00761-015-2918-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gamper EM, Wintner LM, Rodrigues M, Buxbaum S, Nilica B, Singer S, Giesinger JM, Holzner B, Virgolini I. Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme. Eur J Nucl Med Mol Imaging 2015; 42:1179-88. [PMID: 25771905 PMCID: PMC4480943 DOI: 10.1007/s00259-015-3022-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL. METHODS We analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients' baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage. RESULTS A total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6% women; 80.7% papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9% women; 76.3% papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample. CONCLUSION Our results show that the favourable prognosis of DTC does not directly translate into good HRQOL in these patients. Persistent restrictions in regaining their normal daily life in terms of work and leisure highlight the importance of more detailed investigation of DTC patients' wellbeing, support needs, and disease experience.
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Affiliation(s)
- Eva-Maria Gamper
- Department for Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria,
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31
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Bricaire L, Groussin L. Pathologies thyroïdiennes et grossesse. Rev Med Interne 2015; 36:203-10. [DOI: 10.1016/j.revmed.2014.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Gallop K, Kerr C, Simmons S, McIver B, Cohen EEW. A qualitative evaluation of the validity of published health utilities and generic health utility measures for capturing health-related quality of life (HRQL) impact of differentiated thyroid cancer (DTC) at different treatment phases. Qual Life Res 2014; 24:325-38. [PMID: 25106505 DOI: 10.1007/s11136-014-0776-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE This study explored the impact of differentiated thyroid cancer (DTC) on health-related quality of life (HRQL) at different treatment phases and evaluated the validity of published DTC utilities and generic health utility measures (EQ-5D and SF-6D) for economic evaluation of treatments for radio-iodine (RAI) refractory DTC. METHODS Focus groups and interviews were conducted with DTC patients grouped by treatment phase. Qualitative thematic analysis was conducted on interview/focus group transcripts. A thematic coding framework was developed to compare experiences between treatment phases and inform development of a conceptual model. Model concepts were mapped to EQ-5D and SF-6D domains/items. RESULTS Eight focus groups and 11 individual interviews were conducted with 52 DTC patients. Fifty symptoms and HRQL concepts were identified. The impact of DTC and DTC treatment on emotional and cognitive functioning was reported across the treatment phases. The impact on daily activities, mobility, and energy levels was greatest for patients with recurring/persistent or RAI-refractory DTC. Of the 50 concepts, 25 and 27 mapped directly onto domains/items in the EQ-5D and SF-6D, respectively. The SF-6D covered a broader range of DTC impact on emotional/physical problems and daily/social activities than did the EQ-5D. CONCLUSIONS The conceptual model summarizes the wide-ranging impact of DTC and its treatment on patients' HRQL, particularly for those with recurring/persistent or RAI-refractory DTC. Findings suggest that published DTC utilities lack validity for RAI-refractory DTC and that the SF-6D may be more sensitive to HRQL impact of DTC than the EQ-5D.
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Affiliation(s)
- Katy Gallop
- ICON Patient Reported Outcomes, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
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Easley J, Miedema B, Robinson L. It's the "good" cancer, so who cares? Perceived lack of support among young thyroid cancer survivors. Oncol Nurs Forum 2014; 40:596-600. [PMID: 24161638 DOI: 10.1188/13.onf.596-600] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the survivorship experience of young adult patients with thyroid cancer. RESEARCH APPROACH A qualitative, descriptive study. SETTING Four Canadian provinces, with most participants from Ontario. PARTICIPANTS 12 young adult thyroid cancer survivors who participated in a larger study on follow-up care needs consisting of 55 young adult cancer survivors. METHODOLOGIC APPROACH Telephone interviews were conducted with cancer survivors who were diagnosed from age 18-39 years and were 1-5 years post-treatment. FINDINGS All 12 thyroid cancer survivors discussed the feeling that their cancer experiences often were downplayed because thyroid cancer is labeled as the "good" cancer. Many said that they were not considered real patients with cancer by healthcare providers and other patients with cancer, and they were unable or unwilling to access support programs or assistance from healthcare providers. CONCLUSIONS Cancer can have an impact on a person's life regardless of the prognosis. Being diagnosed with thyroid cancer at a young age can pose additional challenges because of the lack of available support to address needs specific to young adults. INTERPRETATION Healthcare providers must recognize the needs of thyroid cancer survivors and encourage them to access supportive services. KNOWLEDGE TRANSLATION Patients with thyroid cancer believe that their needs often are overlooked because of high survival rates, and they have difficulty accessing support resources and finding help. Young adults with cancer often have unique support needs. Support needs may not be the same for all young adult patients with cancer, and those needs should be recognized and addressed.
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Affiliation(s)
- Julie Easley
- Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, New Brunswick, Canada
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Abstract
The focus of this article is on clinical ethics issues in the thyroid disease context. Clinical ethics is a subspecialty of bioethics that deals with bedside ethical dilemmas that specifically involve the provider-patient relationship. Such issues include consent and capacity; weighing therapeutic benefits against risks and side-effects; innovative therapies; end of life care; unintended versus intentional harms to patients or patient populations; and healthcare access. This article will review core ethical principles for practice, as well as the moral and legal requirements of informed consent. It will then discuss the range of unique and universal ethical issues and considerations that present in the management of autoimmune thyroid disease and thyroid cancer.
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Affiliation(s)
- M Sara Rosenthal
- Program for Bioethics, Department of Internal Medicine, University of Kentucky, 740 S. Limestone Street, Suite K-522, Lexington, KY 40506, USA.
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35
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Yim JH, Kim WG, Jeon MJ, Han JM, Kim TY, Yoon JH, Hong SJ, Song DE, Gong G, Shong YK, Kim WB. Association between expression of X-linked inhibitor of apoptosis protein and the clinical outcome in a BRAF V600E-prevalent papillary thyroid cancer population. Thyroid 2014; 24:689-94. [PMID: 24124924 PMCID: PMC3993013 DOI: 10.1089/thy.2012.0585] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The X-linked inhibitor of apoptosis protein (XIAP) is associated with carcinogenesis, cancer progression, and metastasis through inhibition of the caspase-mediated apoptotic pathway. The BRAF(V600E) mutation is the most common genetic alteration and an established prognostic marker in papillary thyroid cancer (PTC). The prevalence of the BRAF mutation is very high and is up to 80% in Korean PTC patients. In the present study, we evaluated the potential role of XIAP expression as a novel prognostic marker to predict recurrence, in combination with the BRAF(V600E) mutational status. METHODS The study enrolled 164 patients with conventional PTC who underwent bilateral thyroidectomy followed by immediate (131)I ablation. The presence of the BRAF(V600E) mutation was evaluated by direct sequencing. The degree of XIAP expression was evaluated by immunohistochemical (IHC) staining using a monoclonal antibody. RESULTS The BRAF(V600E) mutation was found in 123 of 164 patients (75%) with classical PTC. XIAP expression was positive in 128 of 164 patients (75%), and positive XIAP expression was significantly associated with the presence of lateral cervical lymph node metastases (p=0.01). XIAP expression was more frequent in BRAF(V600E) mutated PTCs than in BRAF wild type PTCs (p=0.048). The BRAF(V600E) mutation was significantly associated with cancer recurrence in study subjects (hazard ratio=2.98, p=0.039). PTCs positive for the BRAF(V600E) mutation but negative for XIAP expression had a significantly higher rate of recurrent PTC (hazard ratio=4.53, p=0.012). CONCLUSION The evaluation of XIAP expression and BRAF mutational analysis was more useful for the prediction of cancer recurrence in patients with PTC than BRAF genotype alone.
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Affiliation(s)
- Ji Hye Yim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Min Han
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Husson O, Mols F, Oranje WA, Haak HR, Nieuwlaat WA, Netea-Maier RT, Smit JWA, van de Poll-Franse LV. Unmet information needs and impact of cancer in (long-term) thyroid cancer survivors: results of the PROFILES registry. Psychooncology 2014; 23:946-52. [DOI: 10.1002/pon.3514] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/16/2014] [Accepted: 02/16/2014] [Indexed: 01/07/2023]
Affiliation(s)
- O. Husson
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
| | - F. Mols
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
| | - W. A. Oranje
- Department of Internal Medicine; TweeSteden Hospital; Tilburg The Netherlands
| | - H. R. Haak
- Department of Internal Medicine; Maxima Medical Centre; Eindhoven The Netherlands
| | - W. A. Nieuwlaat
- Department of Internal Medicine; St. Elisabeth Hospital; Tilburg The Netherlands
| | - R. T. Netea-Maier
- Department of Internal Medicine; Radboud Medical Centre; Nijmegen The Netherlands
| | - J. W. A. Smit
- Department of Internal Medicine; Radboud Medical Centre; Nijmegen The Netherlands
| | - L. V. van de Poll-Franse
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Comprehensive Cancer Centre Netherlands South; Eindhoven The Netherlands
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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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Begum F, Ahmed CM, Afroz S, Kabir E, Alam F, Banerjee S, Zaman N. Lean body mass-based levothyroxine replacement in young athyrotic patients with differentiated carcinoma of thyroid. Indian J Endocrinol Metab 2013; 17:254-259. [PMID: 23776898 PMCID: PMC3683200 DOI: 10.4103/2230-8210.109697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to optimize dose of levothyroxine (LT4) based on lean body mass (LBM) in young athyrotic patients with differentiated carcinoma of thyroid (DCT) which has not been properly addressed in Bangladesh before. MATERIALS AND METHODS SIXTY PATIENTS WITH DCT (AGE, RANGE: 20-39 years) having total thyroidectomy followed by radioiodine ablative therapy (RIT) and 23 euthyroid volunteers were recruited. Clinical, biochemical parameters were obtained from all patients after 2 months of RIT and on LT4 replacement at a dose of 200 μg/day as first follow up visit and also from control subjects. Then 60 patients were divided into two groups consisting of 30 patients each. Patients of Group-I received LT4 replacement based on LBM measured by dual energy X-ray absorptiometry (DXA) and Group-II continued LT4 replacement in conventional dose. Patients of both groups were assessed again for same parameters at 6 to 12 months at the second visit. RESULTS Optimized dose of LT4 based on LBM by DXA (131 ±23 μg/day) significantly reduced thyroid hormones and kept thyroid stimulating hormone (TSH) in expected levels in patients of Group-I at the second visit compared to patients of Group-II who continued conventional LT4 dose (200 μg/day). Hyperthyroid symptom scale (HSS) was significantly reduced to 2 ± 1 in patients of Group-I but not in patients of Group-II, HSS, 8 ±1 (P > 0.001). CONCLUSION Optimization of LT4 dose based on LBM can avoid chronic exposure of mild excess of thyroid hormone in young patients with low risk DCT.
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Affiliation(s)
- Fatima Begum
- Institute of Nuclear Medicine and Ultrasound, BAEC, BSMMU Campus, Shahbag, Dhaka, Bangladesh
| | - Chaudhury M. Ahmed
- Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU, Dhaka), Shahbag, Dhaka, Bangladesh
| | - Shahana Afroz
- Bangladesh Atomic Energy Commission, E-12/A, Agargaon, Sher-e-Bangla Nagar, Dhaka, Bangladesh
| | - Enamul Kabir
- Department of Pathology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Faridul Alam
- Institute of Nuclear Medicine and Ultrasound, BAEC, BSMMU Campus, Shahbag, Dhaka, Bangladesh
| | - Sajal Banerjee
- Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU, Dhaka), Shahbag, Dhaka, Bangladesh
| | - Nazma Zaman
- Department of Physics, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
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Husson O, Haak HR, Buffart LM, Nieuwlaat WA, Oranje WA, Mols F, Kuijpens JL, Coebergh JW, van de Poll-Franse LV. Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: a study from the population-based PROFILES registry. Acta Oncol 2013. [PMID: 23181387 DOI: 10.3109/0284186x.2012.741326] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Given the longevity of thyroid cancer patients, any impairment in health-related quality of life (HRQoL) during the follow-up period is of considerable concern. Therefore, the first aim of this study was to assess (thyroid cancer specific) HRQoL among long-term thyroid cancer survivors and to compare this with the HRQoL of an age- and sex-matched normative population. Secondly, our aim was to investigate which clinical and socio-demographic characteristics and thyroid cancer specific problems were associated with HRQoL. MATERIAL AND METHODS All patients diagnosed with thyroid cancer between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a survey on HRQoL (EORTC QLQ-C30) and disease-specific symptoms (THYCA-QoL). The scores were compared with age- and sex-matched cancer free controls (n = 800). A series of multiple linear regression analyses were conducted to investigate the independent associations between clinical, socio-demographic and thyroid cancer specific factors with HRQoL. RESULTS A total of 306 patients (86%) responded to the invitation. Thyroid cancer survivors had significantly lower scores on physical, role, emotional, cognitive and social functioning (p < 0.001) compared to the normative population after adjusting for comorbidities. Sympathetic problems [feeling chilly (52%), hot flushes (40%)], neuromuscular problems [cramp legs (43%) and pain joints/muscles (64%)] and abrupt attacks of fatigue (50%) were the most often reported thyroid cancer specific complaints. Thyroid cancer specific neuromuscular, concentration, sympathetic and psychological problems explained 41-58% of the variance in HRQoL. Clinical and socio-demographic factors explained a small part of the variance in (thyroid cancer specific) HRQoL (1-27%). CONCLUSION Long-term thyroid cancer survivors experience more symptoms and deteriorated HRQoL compared to the normative population. Thyroid cancer specific neuromuscular, sympathetic, concentration and psychological symptoms are stronger associated with HRQoL than clinical and socio-demographic factors alone. Awareness of these specific determinants of HRQoL could help health care practitioners to provide better supportive care.
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Affiliation(s)
- Olga Husson
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, The Netherlands.
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Sawka AM, Straus S, Rotstein L, Brierley JD, Tsang RW, Asa S, Segal P, Kelly C, Zahedi A, Freeman J, Solomon P, Anderson J, Thorpe KE, Gafni A, Rodin G, Goldstein DP. Randomized Controlled Trial of a Computerized Decision Aid on Adjuvant Radioactive Iodine Treatment for Patients With Early-Stage Papillary Thyroid Cancer. J Clin Oncol 2012; 30:2906-11. [DOI: 10.1200/jco.2011.41.2734] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Decision-making on adjuvant radioactive iodine (RAI) treatment for early-stage papillary thyroid cancer (PTC) is complex because of uncertainties in medical evidence. Using a parallel, two-arm, randomized, controlled trial design, we examined the impact of a patient-directed computerized decision aid (DA) on the medical knowledge and decisional conflict in patients with early-stage PTC considering the choice of being treated with adjuvant RAI or not. The DA describes the rationale, possible risks and benefits, and the medical evidence uncertainty relating to the choice. Patients and Methods We recruited 74 patients with early-stage PTC after thyroidectomy. Participants were assigned by using 1:1 central computerized randomization to either the DA group with usual care (intervention) or usual care alone (control). Medical knowledge about PTC and RAI treatment (the primary outcome), as well as decisional conflict (a secondary outcome), were measured by using validated questionnaires, and the respective scores were compared between groups. Results Consistent with PTC epidemiology, 83.8% (62 of 74) of the participants were women, and the mean age was 45.8 years (range, 19 to 79 years). Medical knowledge about PTC and RAI treatment was significantly greater and decisional conflict was significantly reduced in the DA group compared with the control group (respective P values < .001). The use of adjuvant RAI treatment was not significantly different between groups (DA group, 11 of 37 [29.7%]; controls, seven of 37 [18.9%]; P = .278). Conclusion A computerized DA improves informed decision making in patients with early-stage PTC who are considering adjuvant RAI treatment. DAs are useful for patients facing decisions subject to medical evidence uncertainty.
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Affiliation(s)
- Anna M. Sawka
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Sharon Straus
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Lorne Rotstein
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - James D. Brierley
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Richard W. Tsang
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Sylvia Asa
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Phillip Segal
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Catherine Kelly
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Afshan Zahedi
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Jeremy Freeman
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Philip Solomon
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Jennifer Anderson
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Kevin E. Thorpe
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Amiram Gafni
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Gary Rodin
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - David P. Goldstein
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
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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: 96] [Impact Index Per Article: 7.4] [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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Abstract
CONTEXT Substantial uncertainty persists about the indications for radioactive iodine for thyroid cancer. Use of radioactive iodine over time and the correlates of its use remain unknown. OBJECTIVE To determine practice patterns, the degree to which hospitals vary in their use of radioactive iodine, and factors that contribute to this variation. DESIGN, SETTING, AND PATIENTS Time trend analysis of radioactive iodine use in a cohort of 189,219 patients with well-differentiated thyroid cancer treated at 981 hospitals associated with the US National Cancer Database between 1990 and 2008. We used multilevel analysis to assess the correlates of patient and hospital characteristics on radioactive iodine use in the cohort treated from 2004 to 2008. MAIN OUTCOME MEASURE Use of radioactive iodine after total thyroidectomy. RESULTS Between 1990 and 2008, across all tumor sizes, there was a significant increase in the proportion of patients with well-differentiated thyroid cancer receiving radioactive iodine (1373/3397 [40.4%] vs 11,539/20,620 [56.0%]; P < .001). Multivariable analysis of patients treated from 2004 to 2008 found that there was a statistical difference in radioactive iodine use between American Joint Committee on Cancer stages I and IV (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.31-0.37) but not between stages II/III and IV (for stage II vs stage IV, OR, 0.97; 95% CI, 0.88-1.07 and for stage III vs stage IV, OR, 1.06; 95% CI, 0.95-1.17). In addition to patient and tumor characteristics, hospital volume was associated with radioactive iodine use. Wide variation in radioactive iodine use existed, and only 21.1% of this variation was accounted for by patient and tumor characteristics. Hospital type and case volume accounted for 17.1% of the variation. After adjusting for available patient, tumor, and hospital characteristics, 29.1% of the variance was attributable to unexplained hospital characteristics. CONCLUSION Among patients treated for well-differentiated thyroid cancer at hospitals in the National Cancer Database, there was an increase in the proportion receiving radioactive iodine between 1990 and 2008; much of the variation in use was associated with hospital characteristics.
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Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Martins-Filho R, Ward LS, Amorim BJ, Santos AO, Lima MCLD, Ramos CD, Matos PS, Assumpção LVM, Camargo EE, Etchebehere ECSC. Cumulative doses of radioiodine in the treatment of differentiated thyroid carcinoma: knowing when to stop. ACTA ACUST UNITED AC 2011; 54:807-12. [PMID: 21340173 DOI: 10.1590/s0004-27302010000900006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 11/03/2010] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.
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Affiliation(s)
- Raul Martins-Filho
- Division of Nuclear Medicine, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, São Paulo, SP, Brazil
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Sawka AM, Straus S, Gafni A, Meiyappan S, O'Brien MA, Brierley JD, Tsang RW, Rotstein L, Thabane L, Rodin G, George SR, Goldstein DP. A usability study of a computerized decision aid to help patients with, early stage papillary thyroid carcinoma in, decision-making on adjuvant radioactive iodine treatment. PATIENT EDUCATION AND COUNSELING 2011; 84:e24-e27. [PMID: 20732775 DOI: 10.1016/j.pec.2010.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 07/17/2010] [Accepted: 07/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We tested the usability of a patient-directed decision aid (DA), intended for patients with early stage papillary thyroid carcinoma (PTC) deciding to accept or reject adjuvant radioactive iodine (RAI) treatment. This decision is complicated by uncertainty of the medical evidence relating to potential treatment benefits. METHODS The DA was tested by 12 thyroid cancer survivors, 7 thyroid specialty physicians, and 30 lay individuals with no history of thyroid cancer. The participants completed the System Usability Scale for human-computer interaction questionnaire. The medical knowledge of lay participants was assessed before and after DA exposure. Qualitative participant feedback was obtained by thinking aloud during DA use, as well as from interviews. RESULTS Participants generally found the usability of the DA acceptable. The DA significantly increased medical knowledge. In spite of some physicians' concerns about disclosure of treatment controversy and evidence uncertainty, it was found to be acceptable to non-physicians. CONCLUSION A computerized DA on RAI treatment is acceptable to physicians and non-physicians and can improve medical knowledge. PRACTICE IMPLICATIONS In counseling patients about complex medical decisions, disclosure of uncertainty related to medical evidence may be acceptably conveyed using a DA.
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Affiliation(s)
- Anna M Sawka
- Department of Medicine, University Health Network - Toronto General Hospital, Toronto, Canada.
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Sawka AM, Straus S, Gafni A, Brierley JD, Tsang RW, Rotstein L, Ezzat S, Thabane L, Rodin G, Meiyappan S, David D, Goldstein DP. How can we meet the information needs of patients with early stage papillary thyroid cancer considering radioactive iodine remnant ablation? Clin Endocrinol (Oxf) 2011; 74:419-23. [PMID: 21198742 PMCID: PMC3084509 DOI: 10.1111/j.1365-2265.2010.03966.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In patients with early stage papillary thyroid carcinoma (PTC) who have had a thyroidectomy, the decision must be made to accept or reject radioactive iodine remnant ablation (RRA). Counselling patients about this decision can be challenging, given the medical evidence uncertainties and the complexity of related information. Although physicians are the primary source of medical information for patients considering RRA, some patients have a desire for supplemental information from sources such as the internet. Yet, thyroid cancer resources on the internet are of variable quality, and some may not be applicable to the individual case. We have developed a computerized educational tool [called a decision aid (DA)], directed to patients with early stage papillary thyroid cancer, and intended as an adjunct to physician counselling, to relay evidence-based medical information on disease prognosis and the choice to accept or reject RRA. DAs are tools used to inform patients about available treatment options and have been utilized in oncologic decision-making. We tested our web-based DA in fifty patients with early stage PTC and found that it improved medical knowledge. Furthermore, participants found the technical usability of the tool acceptable. We are currently conducting a randomized controlled trial comparing the use of the DA plus usual care to usual care alone to confirm the educational benefit of the website and examine its impact on the decision-making process. In the future, DAs may play an expanded role as an adjunct to physician counselling in the care of patients with thyroid cancer.
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Affiliation(s)
- A M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada.
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Experiences of patients with laryngectomies as they reintegrate into their community. Support Care Cancer 2011; 20:489-98. [PMID: 21298450 DOI: 10.1007/s00520-011-1101-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this qualitative study is to describe the patient's experiences as they reintegrate into the community following laryngectomy surgery and identify their perceived support and barriers within this transition. METHODS Using Thorne's interpretive descriptive approach, purposeful sampling was used to recruit participants from two large urban hospitals. In-depth, audio-taped interviews were conducted with nine participants 6-12 months following surgery. RESULTS Enveloped under an overarching theme of a "Constant Accommodation to Life with a Laryngectomy," were three main themes: (1) "Impact of Cancer Diagnosis," (2) "Coping with Illness: Trying to Live Life like Before," and (3) "Transitions in Recovery." Subthemes further illuminated the constant accommodation participants had to make following cancer recurrence, surgery, and returning home. CONCLUSIONS Patients with laryngectomies face major changes in lifestyle related to altered airway, loss of voice, body image concerns, and challenges with eating. Support of family, friends, and health care professionals is critical for successful transition during this stressful period. Instant messaging, email, Web-based support groups, and video messaging can contribute to a great improvement in communication and engagement for this population.
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Sawka AM, Straus S, Brierley JD, Tsang RW, Rotstein L, Rodin G, Gafni A, Ezzat S, Thabane L, Thorpe KE, Goldstein DP. Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer--a randomized controlled trial. Trials 2010; 11:81. [PMID: 20659341 PMCID: PMC2917435 DOI: 10.1186/1745-6215-11-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/26/2010] [Indexed: 01/18/2023] Open
Abstract
Background Patients with early stage papillary thyroid carcinoma (PTC), are faced with the decision to either to accept or reject adjuvant radioactive iodine (RAI) treatment after thryroidectomy. This decision is often difficult because of conflicting reports of RAI treatment benefit and medical evidence uncertainty due to the lack of long-term randomized controlled trials. Methods We report the protocol for a parallel, 2-arm, randomized trial comparing an intervention group exposed to a computerized decision aid (DA) relative to a control group receiving usual care. The DA explains the options of adjuvant radioactive iodine or no adjuvant radioactive iodine, as well as associated potential benefits, risks, and follow-up implications. Potentially eligible adult PTC patient participants will include: English-speaking individuals who have had recent thyroidectomy, and whose primary tumor was 1 to 4 cm in diameter, with no known metastases to lymph nodes or distant sites, with no other worrisome features, and who have not received RAI treatment for thyroid cancer. We will measure the effect of the DA on the following patient outcomes: a) knowledge about PTC and RAI treatment, b) decisional conflict, c) decisional regret, d) client satisfaction with information received about RAI treatment, and e) the final decision to accept or reject adjuvant RAI treatment and rationale. Discussion This trial will provide evidence of feasibility and efficacy of the use of a computerized DA in explaining complex issues relating to decision making about adjuvant RAI treatment in early stage PTC. Trial registration Clinical Trials.gov Identifier: NCT01083550
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.
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Xing M. Prognostic utility of BRAF mutation in papillary thyroid cancer. Mol Cell Endocrinol 2010; 321:86-93. [PMID: 19883729 PMCID: PMC2849928 DOI: 10.1016/j.mce.2009.10.012] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/18/2009] [Accepted: 10/21/2009] [Indexed: 11/29/2022]
Abstract
Papillary thyroid cancer (PTC) is a common endocrine malignancy that frequently harbors the oncogenic T1799A BRAF mutation. As a novel prognostic molecular marker, this mutation has received considerable attention in recent years for its potential utility in the risk stratification and management of PTC. In PTC, BRAF mutation is closely associated with extrathyroidal extension, lymph node metastasis, advanced tumor stages, disease recurrence, and even patient mortality. Many of the responsible molecular derangements promoted by, or associated with, BRAF mutation have been identified, including over-expression of tumor-promoting genes, suppression of tumor-suppressor genes, and silencing of thyroid iodide-handling genes, resulting in impairment or loss of radioiodine avidity and hence the failure of radioiodine treatment of PTC. BRAF mutation can be readily tested on thyroid fine needle aspiration biopsy specimens, with high preoperative predictive probabilities for clinicopathological outcomes of PTC. As such, the knowledge of BRAF mutation status can facilitate more accurate risk stratification and better decision making at various steps in the management of PTC, from preoperative planning of initial surgical scale to postoperative decisions about appropriate radioiodine treatment and thyroid-stimulating hormone suppression, and to selections of appropriate surveillance modalities for PTC recurrence. The greatest utility of BRAF mutation status is in those cases where traditional clinicopathological criteria alone would otherwise be unreliable in the risk stratification and management of PTC. Use of this unique molecular marker, in conjunction with conventional clinicopathological risk factors, to assist the prognostication of PTC is likely to improve the efficiency of contemporary management of thyroid cancer.
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Affiliation(s)
- Mingzhao Xing
- Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, United States.
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