Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer

Diagnosis and treatment of differentiated thyroid carcinoma (DTC), papillary and follicular, may be associated with poor health-related quality of life (HRQOL), fears of recurrence (FoR) and distress. This is the first time a single FoR screening question (written to complement a HRQOL questionnaire), has been reported alongside HRQOL and levels of distress in patients following DTC. A cross sectional survey was performed in April 2014 of patients treated for DTC presenting to the Merseyside and Cheshire thyroid cancer network between April 2009 and November 2013. Questionnaires comprised of the EORTC QLQ-C30, THYCA-QoL, Emotional Thermometer and the new FoR screening item. A total of 249 surveys were sent and a response of 68% (169) was achieved. The most prevalent HRQOL issues included tiredness, trouble sleeping and needing to rest, pain particularly in muscles/joints, dry mouth, hot flushes and tolerating heat, gaining weight, feeling slowed down, weak, trouble taking long walks or doing strenuous activities, feeling tense, worried, irritable, anxious or having difficulty remembering things. One in seven patients (95% confidence interval 9-21%) responded to the single FoR question that they either got 'a lot of fears of recurrence that really preoccupied their thought' or were 'fearful all the time that their cancer might return and that they struggled with this'. Distress levels overall were relatively low. In conclusion patients with DTC report different HRQOL issues compared to other H&N cancers. There is a subgroup of DTC patients where it would be helpful to identify FoR so they might receive additional support.