Thyroid cancer worry remains after treatment
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More than half of a cohort of adults with thyroid cancer identified disease recurrence, quality-of-life deterioration and familial risk as areas of concern following diagnosis, according to findings published in Thyroid.
“Considering the excellent survival of patients with differentiated thyroid cancer compared with patients with other malignancies, this finding highlights the need for more patient education,” Maria Papaleontiou, MD, assistant professor of internal medicine in the division of metabolism, endocrinology and diabetes at the University of Michigan, told Endocrine Today. “Additionally, this worry about death may be driving increased health care utilization and more intensive care in these patients.”
Papaleontiou and colleagues distributed questionnaires that assessed degrees of worry related to thyroid cancer to 2,215 adults from the Surveillance, Epidemiology, and End Results (SEER) program registries from Los Angeles and Georgia who had developed the disease between 2 and 4 years prior and were free of disease at the time of the survey. Initial diagnoses occurred from 2014 to 2015. In addition to recording demographic and medical information, the survey asked questions related to how participants felt about their treatments, their condition’s effects on their quality of life, how it might affect people in their family’s risk, the chance that the disease would recur and death. Answers were given on a 5-point Likert scale, and the researchers noted that indicating anything other than “not at all” worried was used to define a state of worry.
Cancer recurrence was a concern for 63.2% of the participants. Concern that their family would be more susceptible to the condition was reported by 58% of the participants. Quality of life becoming worse was a worry for 54.7% of the cohort. Treatment harms or complications were a worry held by 43.5% of the participants, and death was a concern for 41%, according to the researchers. In addition, thyroid cancer concern negatively affected the lives of 63.1% of participants based on survey responses. Isolation from family members and friends was reported by 44.8% of the participants, and feeling upset about their condition was reported by 88.2%.
Demographic factors
According to the researchers, men were less likely to be worried about negative effects of treatment (OR = 0.79; 95% CI, 0.62-0.99) and their families being more at risk (OR = 0.64; 95% CI, 0.51-0.8) compared with women.
Participants aged 44 years or younger were more likely to report worry about all aspects than older participants, with the ORs for each type of worry reaching a significantly lower mark for those aged 45 to 54 years, those aged 55 to 54 years and those aged at least 65 years, save for when it came to concerns about treatments for those aged 45 to 54 years.
Hispanic participants were more likely to report concerns about treatments (OR = 1.81; 95% CI, 1.39-2.36), quality of life (OR = 1.46; 95% CI, 1.12-1.9), family risk (OR = 1.51; 95% CI 1.14-1.99) and death (OR = 1.41; 95% CI, 1.09-1.83) than white participants, the researchers reported. In addition, Asian participants were more likely to be concerned about treatments (OR = 1.6; 95% CI, 1.15-2.23) and death (OR = 1.57; 95% CI, 1.13-2.17) related to thyroid cancer than white participants.
“Our finding that Hispanics and Asians were more likely to worry about harms from treatments and death compared with whites indicates a need to focus on these populations with interventions to reduce unnecessary worry,” the researchers wrote. “These results provide new insight on the role of race/ethnicity on cancer-related worry in thyroid cancer survivors that has so far been lacking.”
Educational and medical factors
Worries about treatments (OR = 1.41; 95% CI, 1.09-1.82), family risk (OR = 1.49; 95% CI, 1.15-1.93), recurrence (OR = 1.78; 95% CI, 1.36-2.33) and death (OR = 2.05; 95% CI, 1.58-2.64) were more likely to be reported by participants with a high school diploma or less compared with those with at least a college degree, the researchers found. Similarly, those who reported some college but who did not receive a degree had increased likelihood for worry about treatments (OR = 1.26; 95% CI, 1.01-1.56), family risk (OR = 1.6; 95% CI, 1.29-1.99), recurrence (OR = 1.56; 95% CI, 1.25-1.95) and death (OR = 1.44; 95% CI, 1.16-1.8) compared with those with a college degree.
The researchers noted that a diagnosis of depression was reported by 17.4% of the population before cancer development and that these participants were more concerned about the effects of the disease on quality of life (OR = 1.31; 95% CI, 1.03-1.66) than those who did not have diagnosed depression. In addition, compared with participants without any comorbidities, those with at least two were more likely to express worry about treatments (OR = 1.47; 95% CI, 1.09-1.98) and death (OR = 1.39; 95% CI, 1.02-1.89).
“It appears that there may be a disconnect between actual thyroid cancer risks and patient perceptions of risk,” Papaleontiou said. “Additionally, patient worry about death may be an inappropriate driver for more intensive care, even in those patients who are at low risk. Our findings suggest a need to reduce worry across the care trajectory in at-risk patients with favorable prognosis.” – by Phil Neuffer
For more information:
Maria Papaleontiou, MD, can be reached at mpapaleo@med.umich.edu.
Disclosures: The authors report no relevant financial disclosures.
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