Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea
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RESEARCH
Open Access
Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea Ji In Lee1, Soo Hyun Kim2, Alice H Tan1, Hee Kyung Kim1, Hye Won Jang1, Kyu Yeon Hur1, Jae Hyeon Kim1, Kwang-Won Kim1, Jae Hoon Chung1, Sun Wook Kim1*
Abstract Background: Concern regarding the health-related quality of life (HRQOL) of long-term survivors of thyroid cancer has risen due to the rapid increase in the incidence of thyroid cancer, which generally has an excellent prognosis. The aim of this study was to evaluate the status of HRQOL in disease-free survivors of differentiated thyroid carcinoma (DTC) and to evaluate the important determinants of HRQOL. Methods: This was a cross-sectional study in which we interviewed consecutive disease-free survivors of DTC. Three different validated questionnaires ("EORTC QLQ-C30” for various functional domains, the “brief fatigue inventory (BFI)” and the “hospital anxiety and depression scale” (HADS)) were used. Data from a large, population based survey of 1,000 people were used as a control. Results: The response rate for the questionnaires was 78.9% (316/401). Disease-free survivors of DTC showed a decreased HRQOL in all five functional domains (physical, role, cognitive, emotional, and social) on the EORTC QLQC30 compared with controls (P < 0.01). BFI and HADS-anxiety scores also showed greater distress in disease-free survivors of DTC than in controls (P < 0.05). A multiple regression analysis for the determinants of HRQOL showed that the HADS-anxiety, HADS-depression, and BFI scores were the most significant components of decreased HRQOL. Conclusions: Although disease-free survivors of DTC are expected to have disease-specific survival comparable to the general population, they experience a significantly decreased HRQOL. Anxiety, depression, and fatigue were the major determinants of the decreased HRQOL. Supportive psychological care should be integrated into the management of long-term survivors of DTC.
Background The incidence of thyroid cancer is rapidly increasing in Korea and in several parts of the world. Differentiated thyroid carcinoma (DTC), mostly small papillary thyroid carcinomas which show excellent prognosis [1-3], account for the majority of the increased incidence. Although there are some controversies in the management of DTC (papillary and follicular thyroid carcinoma), primary treatment typically consists of surgery, radioactive iodine (RAI) ablation/treatment, and TSH * Correspondence: [email protected] 1 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Full list of author information is available at the end of the article
suppressive therapy with levo-thyroxine (T4). These treatment options are accompanied by various kinds of long-term complications such as voice change after thyroid surgery and xerostomia after high cumulative dose of RAI [4]. Since most patients with DTC become free of disease after the initial t
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