title: Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme.
abstract: OBJECTIVE
  Health-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL.
  
  
  METHODS
  We analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients' baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage.
  
  
  RESULTS
  A total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6% women; 80.7% papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9% women; 76.3% papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample.
  
  
  CONCLUSIONS
  Our results show that the favourable prognosis of DTC does not directly translate into good HRQOL in these patients. Persistent restrictions in regaining their normal daily life in terms of work and leisure highlight the importance of more detailed investigation of DTC patients' wellbeing, support needs, and disease experience.
authors.affiliation: Department for Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria, eva.gamper@uki.at.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Gamper
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wintner
authors.forename: Margarida
authors.initials: M
authors.lastname: Rodrigues
authors.forename: Sabine
authors.initials: S
authors.lastname: Buxbaum
authors.forename: Bernhard
authors.initials: B
authors.lastname: Nilica
authors.forename: Susanne
authors.initials: S
authors.lastname: Singer
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Giesinger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzner
authors.forename: Irene
authors.initials: I
authors.lastname: Virgolini
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals