Quality of Life in Thyroid Cancer: A Questionnaire Based-Study

By Barbus, Elena; Pestean, Claudiu et al. | Journal of Evidence-Based Psychotherapies, March 2018 | Go to article overview

Quality of Life in Thyroid Cancer: A Questionnaire Based-Study


Barbus, Elena, Pestean, Claudiu, Larg, Maria Iulia, Gabora, Katalin, Cheptea, Marilena, Bonci, Eduard-Alexandru, Badulescu, Claudiu, Piciu, Doina, Journal of Evidence-Based Psychotherapies


Introduction

Thyroid cancer

Thyroid gland is part of the endocrine system with a major role in the normal functioning of the most important metabolic processes. The malignant events of the thyroid are not so uncommon anymore with a worldwide increase in thyroid cancer based on incidental findings (incidentalomas). Another factor that influences the rising incidence is the better access to medical information and health services with a high addressability (Piciu, 2014; Piciu, 2013).

Thyroid cancer treatment follows 3 steps in order to provide disease free status: surgery (total thyroidectomy), radioiodine ablation (if it is necessary according to the international guidelines) and thyroid hormone supplementation with TSH suppression. Every step in the management of the thyroid cancer patients may also comprise different complications (Irimie, 2017; Petrulea, 2015). Complications reported after surgery mainly include physical or functional impairments, including voice and discomfort during swallowing, recurrent laryngeal nerve injury with voice changes, extensive/ keloidal scars. Radioiodine ablation might be associated with acute and long term complications within thyroid cancer patients. Acute risks associated with radioactive iodine include nausea, vomiting, ageusia, salivary gland swelling and sometimes pain/ discomfort. Long-term complications include recurrent sialoadenitis, xerostomia, pulmonary fibrosis, nasolacrimal outflow obstruction and second primary malignancies (Haugen, 2016; Lee, 2010).

The adverse reactions of the long-term hormone treatment, the periodically thyroid hormone withdrawal, the surgery and the subsequent radioiodine treatment might give symptoms affecting the health-related quality of life (HRQoL) (Hedman, Djärv, Strang, & Lundgren, 2016).

Quality of life in thyroid cancer

Thyroid neoplasia with a special emphasis on differentiated thyroid cancer, due to a very long follow-up and risk of recurrence, has been recently studied according to patient's HRQoL. Despite a very good prognosis even in advanced stages, with more than 90 % of the patients reaching disease free status, the new studies regarding the quality of life in thyroid cancer patients reported a high distress in this category of the population (Haugen, 2016; Piciu, 2012). The diagnosis of cancer cannot be forgotten if the patient needs to take his treatment every day and to be followed for long periods of time in order to check the status of the disease. This impacts on the quality of life, especially in young patients due to the very long follow-up (Hedman, Strang, Djärv, Widberg, & Lundgren, 2017).

Even if we expected that the severity of the disease would play a major role in HRQoL the practice revealed a slightly different situation. The superior overall survival in differentiated thyroid cancer patients, despite the stage of the disease, conducts to a modified HRQoL, mostly influenced by the psychological and social aspects of the disease not by the severity or advanced stages. A study conducted by Baohui Zhang et al revealed that the overall quality of life of advanced stage patients is improving if they are out of the hospital environment; the focus on this patients is not in prolonging life but in promoting quality of life (Zhang, Nilsson, & Prigerson, 2012).

Quality of life (QoL) is a broad multidimensional concept that includes individuals' subjective perceptions of their position in life and evaluation of both the positive and negative aspects of life ("The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.," 1998). The quality of life has a subjective component: it can be understood only by the individuals involved and it can be assessed only by them (Cella, 1995). HRQoL is the functional effect of a medical condition and/or its consequent therapy upon a patient. Measuring the HRQoL can give us an overview of the burden in a specific disease. …

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