Quality Of Life In Thyroid Cancer

It is well documented, that cancer of any kind has profound effects on QoL at some stage during its disease course. For TC, several features have unique implications for the relationship between clinical disease, treatment, and QoL.

DTC is the most common endocrine cancer worldwide and increasing over time at least in some populations (1, 2). It has a good survival rate depending on histological type and patient demography.

Surgery is the initial treatment of patients with TC (3). The main principle in the surgical treatment is total thyroidectomy (TTx), which postoperatively allows effective radioactive iodine (RAI) treatment with subsequent optimal follow-up for development of recurrence by the tumour marker serum thyroglobulin (Tg). In general, when an indication for thyroidectomy (Tx) is present, the surgical decision regarding initial operative extent is driven by multiple factors including symptoms, primary etiology, presence of contralateral nodular disease, thyroid functional status, comorbidities, family history, surgical risk, comparative outcomes, and patient preferences. In patients with a low risk of recurrence lobectomy/hemithyroidectomy (hemi-Tx) may be an adequate surgical treatment modality.

On top of the psychological aspects of receiving a cancer diagnosis, the adequacy of early endocrine managements affects the QoL of the patients to a high degree. High-risk patients require a longer period with suppressed thyrotropin (TSH). When the oncologist declares the patient low risk concerning relapse of the cancer after varying lengths of time according to guidelines (4, 5), the endocrine follow-up moves to more focus on reducing the risks of long-term endocrine complications such as declining bone mineral content, muscle mass, cognitive dysfunctions and QoL as well as increased cardiovascular risk and reduced life expectancy (6, 7). Follow-up of the cancer recurrence is based on the determination of serum concentrations of Tg (and its antibodies) and neck ultrasonography, eventually supplemented with other imaging modalities (4, 5, 6, 8).

A recent systematic review of health-related QoL following TC highlighted physical, emotional, and social issues concerning QoL, which could be associated with detrimental outcomes following TC (9).

Two other recent reviews focused instruments measuring TC specific QoL and they concluded, that none of the existing instruments had been sufficiently validated in the TC survivor population (10, 11) and their cross-cultural applicability was low (11).

The purpose of the present study was to summarize the findings regarding the measurement properties of existing TC specific QoL instruments and to explore the impact of DTC on QoL within a clinical framework considering the characteristic of the disease course, as outlined above.

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