Clinical factors associated with worse quality-of-life scores in United States thyroid cancer survivors

Surgery. 2019 Jul;166(1):69-74. doi: 10.1016/j.surg.2019.01.034. Epub 2019 Mar 18.


Introduction: Thyroid cancer survivors are a rapidly growing population in the United States. The factors that drive health-related quality of life (HRQOL) in this population have not been well characterized. We hypothesized that more aggressive treatments and greater treatment-related adverse effects would be associated with worse HRQOL scores in thyroid cancer survivors.

Methods: Thyroid cancer survivors (18-89 years of age) completed an online survey regarding their clinical history in addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) 29 instrument. Univariable and multivariable modeling were performed to evaluate factors associated with worse HRQOL scores. We generated β-values and 95% confidence intervals to quantify the effect of each independent variable in the model.

Results: Thyroid cancer survivors (n = 1,743) reported a high incidence of complications related to surgery and radioactive iodine ablation. Postoperative dysphonia (ß 1.83-3.07) and dysphagia (ß 2.05-3.65) predicted worse HRQOL scores across multiple PROMIS domains. Younger patient age (age <45 years) and short- or long-term complications of radioactive iodine, including gastrointestinal symptoms (51.9%), appetite changes (71.2%), sialadenitis (58.1%), xerostomia (73.3%), and xerophthalmia (45.1%) were associated with worse HRQOL scores (P < .01).

Conclusion: The factors associated with significantly worse HRQOL scores across multiple PROMIS domains for thyroid cancer survivors included patient age <45 years, postoperative hypocalcemia, dysphonia, dysphagia, scar appearance, and complications from radioactive iodine. Methods of evaluation, management, and prevention of these factors might positively impact HRQOL.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cancer Survivors / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Prognosis
  • Quality of Life*
  • Risk Assessment
  • Sex Factors
  • Surveys and Questionnaires
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / psychology*
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / methods*
  • Thyroidectomy / psychology
  • Treatment Outcome
  • United States
  • Young Adult