Quality of life in patients with non-metastatic differentiated thyroid cancer under thyroxine supplementation therapy

Goals. When thyroid and other cancers are 'cured' it is often assumed that the patients are able to resume their normal lives. This was a cross-sectional study to evaluate health-related quality of life (HRQOL) and to identify rehabilitation needs of patients with non-metastatic thyroid cancer under thyroxine supplementation therapy. Patients and methods. Included in the study were 150 consecutive patients with differentiated thyroid cancer (age 52+/-14 years, range 25-83 years; male/female 39/111). All patients had a history of total thyroidectomy followed by radioiodine ablation, were free of metastatic disease and under levothyroxine treatment. The mean period since the diagnosis of thyroid cancer was 5.5+/-6 years (range 0-23 years). Health-related quality of life was evaluated using the SF-36 Health Survey. The findings were compared with sex- and age-matched reference values. Results. 'Role-emotional' and 'Vitality' were significantly lower (P<0.001 and P<0.005, respectively) in the group as a whole (n=150). In the subgroup of patients with a recent (less than 1 year) diagnosis of thyroid cancer (n=51), however, the following subscales were significantly lower: 'Mental Health' (P<0.01), 'Role-emotional' (P<0.001), 'Role-physical' (P<0.005), 'Social functioning' (P<0.005) and 'Vitality' (P<0.001). Multiple regression analysis identified a significant positive correlation between 'Mental Health', 'Physical functioning', 'Vitality', 'Role-emotional' and 'Social functioning' with the time since initial diagnosis, and there was also a positive correlation between 'Physical functioning', 'Bodily pain' and 'Role-emotional' with male gender. Conclusions. These findings indicate that 'Vitality', 'Role-physical', 'Mental Health', 'Role-emotional' and 'Social functioning' are significantly impaired during the first year after diagnosis. Thereafter, quality of life improves correlating with the time since initial diagnosis. However, 'Vitality' and 'Role-emotional' remain permanently impaired in thyroid cancer patients. A multidisciplinary rehabilitation concept should include psychological support and an early start to exercise to improve physical performance of these patients leading to better HRQOL and to help them fulfill their social role earlier.