, Choi, Horace Cheuk-wai2
, Lee, Victor Ho-fun2
, Wan, Koon-yat1
, Chan, Michelle Fong-ting1
, Wong, Kai-pun3
, Lang, Brian3
, Yuen, Kwok-keung1
, Leung, To-wai1
1 Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
2 Department of Clinical Oncology, Li Kai Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
3 Department of Surgery, Li Kai Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
Health-related quality of life (HRQoL) is important in thyroid cancer survivors, but data is lacking among Asian.
This cross-sectional study aimed to identify any disease-related/ treatment-related factors that affect HRQoL in Asian thyroid cancer survivors and to develop a simple tool to identify patients who need additional support.
All adult differentiated thyroid cancer patients with stable disease >=1 year received a survey on HRQoL using EORTC QLQ-C30 and THYCA-QoL (total: 54 questions). Determinants for HRQoL were selected using multiple linear regressions with backward elimination. For QLQ-C30 and THYCA-QoL domains which could discriminate patients with or without unmet needs, the potential cut-off scores were calculated using receiver operating characteristic (ROC) curve.
A total of 549 patients completed both questionnaires (response rate: 86.9%; female: 79.6%; median survivorship: 7.4 years [1.0-48.2]). Patients with age>=45, TSH>1.85mIU/L, previous radiotherapy and psychiatric illness reported significantly worse QLQ-C30_summary-score (coefficients 2.7-11.3, p<=0.016) and THYCA-QoL_total-score (coefficients 2.7-9.1, p<=0.029). Psychiatric illness (n=34/549, 6.4%) also showed significant effect in most of the symptom scales.
Global Health Status (GHS) in QLQ-C30 was highly predictive for overall HRQoL (QLQ-C30_summary-score and THYCA-QoL_ total-score). Cut-off of 10/14 in GHS could distinguish the bottom 18.9 and 25.1% in our population, respectively (area under ROC curve [AUC]>=0.79, sensitivity (SN)>=0.81, specificity (SP)>=0.61). Moreover, cut-off of 7/16 in THYCA-QoL_psychological-scale (AUC=0.75, SN=0.884, SP=0.612) could screen those at risk of psychiatric illness.
Factors decreasing HRQoL included age>=45, TSH>1.85, previous radiotherapy and presence of psychiatric illness. Using GHS and THYCA-QoL_psychological-scale as a six-item tool can easily identify those with lower HRQoL or risk of psychiatric illness.
- Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, . The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76.
- EORTC QLQ-C30 manual. Available at https://www.eortc.be/qol/files/SCManualQLQ-C30.pdf
- Husson O, Haak HR, Mols F, Nieuwenhuijzen GA, Nieuwlaat WA, Reemst PH, Huysmans DA, Toorians AW, van de Poll-Franse LV. Development of a disease-specific health-related quality of life questionnaire (THYCA-QoL) for thyroid cancer survivors. Acta Oncol. 2013 Feb;52(2):447-54. doi: 10.3109/0284186X.2012.718445. Epub 2012 Sep 27.