Thyroid Cancer Survivors Experience Persistent Symptoms and Health-Related Quality-of-Life Deficits 12 Months Following Surgery

Background: Thyroid cancer survivors may experience significant health-related quality-of-life (HRQoL) detriments. Currently available HRQoL survey tools, used in isolation, can be insensitive to change over time and may incompletely assess thyroid cancer-specific symptoms and fear of cancer recurrence. This study aimed to measure the trajectory of HRQoL changes in thyroid cancer survivors using repeated measures, comparing commonly used surveys, over the first 12-18 months following diagnosis. Methods: A prospective longitudinal cohort study recruited all patients with newly diagnosed thyroid cancer (excluding low-risk papillary thyroid microcarcinoma and anaplastic thyroid cancer) from a mixed metropolitan and regional health district (public and private). Patients were invited to complete Short Form-12 (SF-12), EORTC-QLQ-C30, Thyroid Cancer Quality of Life (ThyCaQoL) Survey, City of Hope-Thyroid Version, and Assessment of Survivor Concerns surveys postoperatively, and at 3, 6, and 12 months. Responses were assessed for changes over time, and multivariable analysis was used to identify variables associated with outcomes at follow-up. Results: Between January 2021 and June 2023, 111 patients completed surveys at a minimum of one time point (response rate 59%). Most were female (72%), mean age 55 years, 56% metropolitan, 56% privately insured, 55% American Thyroid Association low-risk differentiated thyroid cancer. Treatment included surgery (total thyroidectomy 49%, two-stage thyroidectomy 24%, lobectomy 25%, active surveillance 2%); 58% received radioactive iodine ablation. At the completion of the study, 82% were euthyroid and 92% disease-free. At all time points, SF-12 physical and mental component scores (PCS and MCS), remained below normative population values (>12 months; mean PCS = 39.4, mean MCS = 46.7, normative = 50). MCS showed more consistent improvement over the first year following thyroid cancer diagnosis (global p = 0.03). ThyCaQoL surveys identified improvement in voice and scar symptoms (p < 0.01 each), but distress regarding neuromuscular (p < 0.01), sensory symptoms (p = 0.01), and weight gain (p = 0.04) worsened over the course of the study. Fear of cancer recurrence was common and persisted over time. Conclusion: A year after diagnosis, thyroid cancer survivors have persisting HRQoL deficits with some symptoms worsening over time. As part of follow-up care, clinicians should specifically inquire about persistent symptoms that could affect HRQoL. Supportive care interventions for those with persistent HRQoL deficits are required.