Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study

Abstract

Background: Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence and need for lifelong follow-up. The aim was to study changes in health-related quality of life (HRQoL) from diagnosis to one year of follow-up.

Methods: In this prospective population-based study, patients were identified from all the Swedish departments of oncology treating DTC. In total, 487 patients diagnosed with DTC between 2012 and 2017 were invited to answer the Swedish version of the Short Form-36 Health Survey (SF-36) and a study-specific questionnaire at diagnosis and after one year.

Results: In total, 349 (72%) patients responded. Of these, 235 (67%) had reached one year of follow-up and also answered the questionnaire after one year. Of those, 23% had a negative view of life, and 75% had a fear of recurrence at diagnosis. These patients had a significantly lower HRQoL on eight and five of the SF-36 domains, respectively (p < 0.05). A negative view of life and a fear of recurrence also affected HRQoL negatively after one year of follow-up, with a significantly lower HRQoL on seven SF-36 domains for those reporting a negative view of life or fear of recurrence often (p < 0.05). Thyrotropin suppression did not affect HRQoL negatively. In regression models, HRQoL at diagnosis was the most important predictive factor for HRQoL at the one-year follow-up.

Conclusions: Despite a good prognosis, HRQoL was substantially affected at the time of diagnosis, with some improvements after one year. As fear of recurrence and a negative view of life substantially affect HRQoL, these patients should be given additional attention.

Keywords: TSH; fear of recurrence; population-based; prospective; quality of life; thyroid cancer.