Status of mental and social activities of young and middle-aged patients after papillary thyroid cancer surgery

Abstract

Background: Papillary thyroid cancer (PTC) is prevalent among younger populations and has a favorable survival rate. However, a significant number of patients experience psychosocial stress and a reduced quality of life (QoL) after surgical treatment. Therefore, comprehensive evaluations of the patients are essential to improve their recovery.

Methods: The present study enrolled 512 young and middle-aged patients diagnosed with PTC who underwent surgery at our institution between September 2020 and August 2021. Each participant completed a series of questionnaires: Generalized Anxiety Disorder 7 (GAD-7), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL), and Readiness to Return-to-Work Scale (RRTW).

Results: GAD-7 data showed that almost half of the study subjects were experiencing anxiety. Regarding health-related quality of life (HRQoL), participants reported the highest levels of fatigue, insomnia, voice problems, and scarring, with patients in anxious states reporting worse symptoms. Based on RRTW, more than half of the subjects had returned to work and had better HRQoL compared to the others who were evaluating a possible return to work. Age, gender, BMI, education, diet, residence, health insurance, months since surgery, monthly income, and caregiver status were significantly correlated with return to work. Additionally, having a caregiver, higher monthly income, more time since surgery, and living in a city or village were positively associated with return to work.

Conclusion: Young and middle-aged patients with PTC commonly experience a range of health-related issues and disease-specific symptoms following surgery, accompanied by inferior psychological well-being, HRQoL, and work readiness. It is crucial to prioritize timely interventions targeting postoperative psychological support, HRQoL improvement, and the restoration of working ability in PTC patients.

Keywords: mental state; papillary thyroid cancer; quality of life; social activities; young and middle-aged.

Figure 1

Diagram of the Data Collection Process. This study included young and middle-aged patients diagnosed with PTC admitted to our department from Sep. 2020 to Aug. 2021; a total of 569 patients were enrolled firstly. Then, according to our inclusion and exclusion criteria, 46 patients were excluded as follow, 3 patients suffered with other cancers; 21 patients radioiodine therapy; 17 patients had a history of psychiatric diagnosis; 5 patients suffered from primary hyper- or hypothyroidism; and 11 patients lost to follow-up. Finally, a total of 512 PTC patients fulfilled the criteria and were included in this study.

Figure 2

Nomogram to predict anxiety occurrence in PTC patients after surgery. The nomogram to predict anxiety-risk is based on the above four predictive factors. To use the nomogram, the value of each factor is placed on each variable axis and a line is drawn upward to determine the number of received points for each value of the factor. The sum of these values is located on the total point axis and a line down the bottom axis is drawn to determine the probability of anxiety.

Figure 3

Nomogram to predict RRTW in PTC patients after surgery. Each predictive variable, such as age, gender, BMI, caregiver, health insurance, monthly income, time after surgery, and residence, is assigned a point value based on its coefficient in the logistic regression model. To use the nomogram, the value of each factor is placed on each variable axis and a line is drawn upward to determine the number of received points for each value of the factor. The total points accrued from all predictive variables are used to determine the probability of RTW, as indicated on the scale at the bottom of the nomogram.