Effect of Initial Treatment Choice on 2-year Quality of Life in Patients with Low-risk Papillary Thyroid Microcarcinoma

2020 ◽  
Author(s):  
Jae Hoon Moon ◽  
Chang Hwan Ryu ◽  
Sun Wook Cho ◽  
June Young Choi ◽  
Eun-Jae Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Progression ◽  
Active Surveillance ◽  
Initial Treatment ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Abstract Context The long-term quality of life (QoL) in patients with low-risk papillary thyroid microcarcinoma (PTMC) underwent active surveillance (AS) and immediate surgery is unclear. Objective The aim of this study was to investigate the effect of initial treatment choice on 2-year QoL in patients with low-risk PTMC Design, Setting, and Participants We analyzed 2652 QoL surveys from 1055 subjects enrolled in ongoing multicenter prospective cohort study on active surveillance of PTMC, in which the median follow-up duration was 24.4 months. Major Outcome Measure We evaluated QoL of patients with low-risk PTMC according to their treatment modality using generalized estimating equation. Results Six hundred and seventy-four subjects (male = 161; mean age = 48.8 ± 11.9 years) with low-risk PTMC chose AS while 381 subjects (male = 75; mean age = 45.7 ± 10.4 years) chose immediate surgery, including lobectomy/isthmusectomy (L/I) and total thyroidectomy (TT). Among the 817 subjects who completed baseline QoL surveys, 2-year QoL was good in order of AS (n = 500), L/I (n = 238), and TT (n = 79) groups after adjustment for age, sex, baseline tumor size, and baseline QoL scores. Among the 101 subjects who changed their treatment from AS to surgery during the follow-up period, 35 subjects who changed treatment due to disease progression had better QoL than 66 subjects who had no disease progression. Conclusions This study identified QoL as a major issue in choosing an initial treatment of low-risk PTMC and highlighted the possibility of using AS as the primary treatment.

QUALITY OF LIFE IN PATIENTS WITH LOW-RISK PAPILLARY THYROID MICROCARCINOMA: ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY

2020 ◽  
Vol 26 (12) ◽  
pp. 1451-1457 ◽  
Author(s):  
Tomohiko Nakamura ◽  
Akira Miyauchi ◽  
Yasuhiro Ito ◽  
Mitsuru Ito ◽  
Takumi Kudo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Active Surveillance ◽  
Depression Scale ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Health Related ◽  
Immediate Surgery ◽  
Specific Health

Objective: This study aimed to compare the quality of life (QoL) and psychological issues of patients with papillary thyroid microcarcinoma (PMC) who were under active surveillance (AS) and those who underwent immediate surgery (OP). Methods: This was a cross-sectional study conducted on 347 patients with low-risk PMC who were under AS (n = 298) or who underwent OP (n = 49). They were asked to complete two questionnaires (thyroid cancer–specific health-related QoL [THYCA-QoL] and the Hospital Anxiety and Depression Scale [HADS]). The results between the AS and OP groups were compared. Results: The mean ages of patients in the AS and OP groups were 58.6 ± 12.5 and 58.4 ± 13.1 years ( P = .94), respectively, and the male ratios were 34/298 (11%) and 2/49 (4.1%) ( P = .14), respectively. The median follow-up periods from diagnosis in the AS and OP groups were 56.5 months (interquartile range [IQR], 32 to 88 months) and 84 months (IQR, 64 to 130 months) ( P<.001), respectively. In the THYCA-QoL questionnaire, the OP group had more complaints about “voice” ( P<.001), “psychological” ( P = .025), “problems with scar” ( P<.001), and “gained weight” ( P = .047) than the AS group. Other scales of the THYCA-QoL were comparable in the two groups. In the HADS questionnaire, the AS group had significantly better anxiety ( P = .020), depression ( P = .027), and total scores ( P = .014) than the OP group. Conclusion: PMC patients in the OP group had more complaints and were more anxious and depressed than the AS group. These findings suggest that AS is a reasonable alternative to surgery for patients with low-risk PMC from the point of view of QoL and psychology. Abbreviations: AS = active surveillance; CI = confidence interval; HADS = Hospital Anxiety and Depression Scale; LT4 = levothyroxine; OP = immediate surgery; PMC = papillary microcarcinoma; PTC = papillary thyroid carcinoma; QoL = quality of life; STAI = State-Trait Anxiety Inventory; THYCA-QoL = thyroid cancer–specific health-related quality of life; TSH = thyrotropin

scholarly journals OR28-06 Assessment of Long Term Quality of Life According to Treatment Options in Low Risk Papillary Thyroid Microcarcinoma Patients - Active Surveillance or Immediate Surgery, (A Follow up Interim Analysis of Maestro)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Soo Myoung Shin ◽  
Sung Hye Kong ◽  
Junsun Ryu ◽  
Min Joo Kim ◽  
Sun Wook Cho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Active Surveillance ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Long Term Follow Up ◽  
Immediate Surgery

Abstract Background: The Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) started in June 2016. As a follow-up study of comparing the quality of life (QoL) of the active surveillance (AS) and immediate surgery (OP) groups at 8 months (9.3±4.8 and 7.1±4.2 months, respectively), here we aimed to compare the QoL between the AS and OP groups after 18 months (22.8±4.0 and 22.3±4.3 months, respectively) of follow-up. Methods: QoL of 108 participants who chose AS, 101 who underwent OP, twelve who changed from AS to OP was evaluated using a thyroid-specific QoL questionnaire at diagnosis and during follow-up (median 23 months). Results: The mean ages of the participants in the AS and OP groups were 47.7±11.0 and 45.1±10.0 years (p=0.075), respectively. At baseline, better physical (8.2±1.4 vs. 7.6±1.8, p=0.032), psychological (7.4±1.2 vs. 6.7±1.6, p=0.010), and total health (7.4±1.0 vs. 6.7±1.3, p=0.005) were observed in the AS group than in the OP group. After a mean follow up of 22.7±4.2 months, better physical (8.1±1.5 vs. 7.4±1.7, p=0.008), psychological (7.7±1.3 vs. 7.0±1.5, p=0.002), and total health (7.5±1.2 vs. 6.8±1.3, p=0.001) were observed in the AS group than in the OP group, whereas spiritual health was comparable between the two groups: compared with the AS group, the OP group experienced more alterations in appetite, sleep, menstrual cycle, voice, motor skill, weight, appearance, cold or heat tolerance, and body swelling. Furthermore, better QOL scores were observed in the AS group in self-concept, personal relationships, sexual life, work motivation, productivity and quality of work, feeling of isolation, driving, doing household chores, preparing meals and doing leisure activities after long term follow up. Conclusion: Patients who underwent AS had better QOL even after long term follow up. Low risk papillary thyroid microcarcinomas do not influence survival, however surgery related deterioration of QOL lasted long and did not improve even in late post-operative stages when patients were fully recovered from surgery. Keywords: Quality of life; papillary thyroid microcarcinoma; active surveillance; immediate surgery

scholarly journals Supraclavicular Approach of Lobectomy Improves Quality of Life for Patients With Unilateral Papillary Thyroid Microcarcinoma: A Prospective Cohort Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Shuai Xue ◽  
Qiuli Wang ◽  
Guang Chen ◽  
Peisong Wang ◽  
Li Zhang
Keyword(s):  
Quality Of Life ◽  
Clinicopathological Features ◽  
Papillary Thyroid ◽  
Central Lymph Node ◽  
Supraclavicular Approach ◽  
Thyroid Microcarcinoma ◽  
Postoperative Symptoms ◽  
Central Lymph

ObjectivePostoperative neck symptoms, including pain, swelling, uncomfortable feelings during swallowing, and incision adhesion formation, are common in patients after lobectomy through the traditional middle neck approach. A new unilateral supraclavicular approach is proposed to protect the anterior cervical region and reduce related complications. The aim of this study is to investigate the efficacy, safety, and advantages of the supraclavicular approach in lobectomy for unilateral papillary thyroid microcarcinoma (PTMC).MethodsTwo hundred sixty-three patients were recruited into either a conventional middle group (CM) or a new supraclavicular (NS) group. Clinicopathological features, surgically related variables, and postoperative symptoms were recorded. Quality of life (QOL) of all patients was assessed by the 12-item short-form health survey (SF-12) and thyroid cancer-specific QOL (THYCA-QoL) questionnaire in 3 and 12 months.ResultsThere were no statistically significant differences in clinicopathological features (including sex, age, multifocality, extrathyroidal extension, histological variants, largest tumor diameter, Hashimoto’s thyroiditis, metastasized central lymph node, removed central lymph node, surgeon, BRAF mutation, and follow-up duration), hospitalization (including hospital cost, surgery time, and blood loss during surgery), and complications between the two groups. Patients who underwent lobectomy through the NS approach had significantly better SF-12 physical, mental, and THYCA-QoL than the CM group patients in both 3 and 12 months (all p &lt; 0.001). Moreover, the NS group had a shorter hospitalization time.ConclusionIn conclusion, the NS approach for lobectomy is a safe and effective method for reducing postoperative symptoms and increasing QOL in patients with unilateral PTMC in both 3 and 12 months’ follow-up.

scholarly journals Active Surveillance of Papillary Thyroid Microcarcinoma: Where Do We Stand?

2019 ◽  
Vol 8 (6) ◽  
pp. 298-306 ◽  
Author(s):  
Min Ji Jeon ◽  
Won Gu Kim ◽  
Ki-Wook Chung ◽  
Jung Hwan Baek ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Volume Measurement ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Major Drawback ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

The recent sharp increase in thyroid cancer incidence is mainly due to increased detection of small papillary thyroid microcarcinoma (PTMC). Due to the indolent nature of the disease, active surveillance (AS) of low-risk PTMCs is suggested as an alternative to immediate surgery to reduce morbidity from surgery. For appropriately selected PTMC patients, AS can be a good management option and surgical intervention can be safely delayed until progression occurs. Many considerations must be taken into account at the time of initiation of AS, including radiological tumor characteristics and clinical characteristics of the patient. A specialized medical team should be assembled to monitor patients during AS with an appropriate follow-up protocol. The fact that some patients require surgery for disease progression after long-term follow-up is a major drawback of the current AS protocol. Evaluation of tumor kinetics by three-dimensional tumor volume measurement during the initial 2–3 years of AS may be helpful for discrimination of PTMCs that need early surgical intervention. In this review, we will discuss the clinical outcomes of surgical intervention and AS, considerations during AS, and unresolved questions about AS.

scholarly journals Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Sangeet Ghai ◽  
Ciara O’Brien ◽  
David P. Goldstein ◽  
Anna M. Sawka ◽  
Lorne Rotstein ◽  
...  
Keyword(s):  
Disease Progression ◽  
Active Surveillance ◽  
Imaging Modality ◽  
Nodular Goiter ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Forward Selection ◽  
Accurate Identification ◽  
Case Selection

AbstractActive surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.

scholarly journals A new paradigm in low-risk papillary microcarcinoma: active surveillance

2017 ◽  
Vol 2017 ◽  
Author(s):  
Alex González Bóssolo ◽  
Michelle Mangual Garcia ◽  
Paula Jeffs González ◽  
Miosotis Garcia ◽  
Guillermo Villarmarzo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Active Surveillance ◽  
Papillary Thyroid Microcarcinoma ◽  
Management Approach ◽  
American Thyroid Association ◽  
List Type ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

Summary Classical papillary thyroid microcarcinoma (PTMC) is a variant of papillary thyroid carcinoma (PTC) known to have excellent prognosis. It has a mortality of 0.3%, even in the presence of distance metastasis. The latest American Thyroid Association guidelines state that although lobectomy is acceptable, active surveillance can be considered in the appropriate setting. We present the case of a 37-year-old female with a history of PTMC who underwent surgical management consisting of a total thyroidectomy. Although she has remained disease-free, her quality of life has been greatly affected by the sequelae of this procedure. This case serves as an excellent example of how first-line surgical treatment may result more harmful than the disease itself. Learning points: Papillary thyroid microcarcinoma (PTMC) has an excellent prognosis with a mortality of less than 1% even with the presence of distant metastases. Active surveillance is a reasonable management approach for appropriately selected patients. Patients should be thoroughly oriented about the risks and benefits of active surveillance vs immediate surgical treatment. This discussion should include the sequelae of surgery and potential impact on quality of life, especially in the younger population. More studies are needed for stratification of PTMC behavior to determine if conservative management is adequate for all patients with this specific disease variant.

scholarly journals MON-494 Quality of Life in Patients with Papillary Thyroid Microcarcinoma According to the Treatment: Total Thyroidectomy Versus Total Thyroidectomy with Radioactive Iodine Remnant Ablation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jonghwa Ahn ◽  
Min Ji Jeon ◽  
Eyun Song ◽  
Tae Yong Kim ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Remnant Ablation ◽  
Thyroid Microcarcinoma ◽  
Significant Difference

Abstract Background: Recently, the role of radioactive iodine (RAI) ablation in the treatment of low risk differentiated thyroid carcinoma (DTC), especially for papillary thyroid microcarcinoma (PTMC), is controversial. This study aims to compare quality of life (QoL) parameters in patients with PTMC underwent total thyroidectomy (TT) versus TT with RAI ablation. Methods: In this cross-sectional study, patients with PTMC who underwent TT with/without RAI remnant ablation were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: 12-item short-form health survey (SF-12), thyroid cancer specific quality of life (THYCA-QOL), and fear of progression (FoP). Results: The TT and TT with RAI groups comprised 107 and 183 patients, respectively. The TT with RAI group had significantly lower serum TSH level than TT group. However, after matching of TSH level between the groups (TT with RAI = 100, TT = 100), there was no significant difference in baseline characteristics. According to the SF-12, the score for general health showed significantly lower in TT with RAI group than TT group (p = 0.047). The THYCA-QOL also showed statistically significant difference in felt chilly score between the groups (p = 0.023). No significant differences in FoP scores were seen between the groups. Conclusion: Patients with PTMC underwent TT with RAI ablation experienced more health-related problems than those managed by TT alone. These findings support RAI ablation should be carefully determined in patients with low-risk DTCs.

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