Worry in Thyroid Cancer Survivors with a Favorable Prognosis

Abstract

Background: Little is known about cancer-related worry in thyroid cancer survivors with favorable prognosis. Methods: A diverse cohort of patients diagnosed with differentiated thyroid cancer in 2014-2015 from the Surveillance, Epidemiology, and End Results (SEER) Program registries of Georgia and Los Angeles County were surveyed two to four years after diagnosis. Main outcomes were any versus no worry about harms from treatments, quality of life, family at risk for thyroid cancer, recurrence, and death. After excluding patients with recurrent, persistent, and distant disease, multivariable logistic regression was used to identify correlates of worry in 2215 disease-free survivors. Results: Overall, 41.0% reported worry about death, 43.5% worry about harms from treatments, 54.7% worry about impaired quality of life, 58.0% worry about family at risk, and 63.2% worry about recurrence. After controlling for disease severity, in multivariable analyses with separate models for each outcome, there was more worry in patients with lower education (e.g., worry about recurrence, high school diploma and below: odds ratio [OR] 1.78, 95% confidence interval [CI 1.36-2.33] compared with college degree and above). Older age and male sex were associated with less worry (e.g., worry about recurrence, age ≥65 years: OR 0.28 [CI 0.21-0.39] compared with age ≤44 years). Worry was associated with being Hispanic or Asian (e.g., worry about death, Hispanic: OR 1.41 [CI 1.09-1.83]; Asian: OR 1.57 [CI 1.13-2.17] compared with whites). Conclusions: Physicians should be aware that worry is a major issue for thyroid cancer survivors with favorable prognosis. Efforts should be undertaken to alleviate worry, especially among vulnerable groups, including female patients, younger patients, those with lower education, and racial/ethnic minorities.

Keywords: death; recurrence; survivors; thyroid cancer; worry.

FIG. 1.

Flow diagram demonstrating sample selection.

FIG. 2.

Patient report of specific worries two to four years after thyroid cancer diagnosis (weighted %).

FIG. 3.

Multivariable analyses of patient characteristics associated with specific worries. Specific worries include harm from treatments, quality of life not being the same as before thyroid cancer diagnosis, family members at risk for thyroid cancer, recurrence, and death.

FIG. 4.

Impact of worry on patients' lives (weighted %).