Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: A study from the population-based PROFILES registry

Figures & data

Figure 1. Flow-chart of the data collection process.

Table I. Socio-demographic and clinical characteristics of questionnaire respondents and normative population.

	n (%)
	Respondents (n = 306)	Normative population (n = 800)	p-value
Age at time survey in years [mean (±SD)]	56.4 (14.5)	55.1 (13.5)	0.2
Years since diagnosis	9.6 (5.5)	-	-
25th percentile	4.7	-
Median	9.0	-
75th percentile	13.5	-
Sex			0.9
Male	76 (24.8%)	200 (25.0%)
Female	230 (75.2%)	600 (75.0%)
Type of thyroid cancer			-
Papillar	217 (70.9%)	-
Follicular (including Hurthle cell)	73 (23.8%)	-
Medullary	13 (4.2%)	-
Stage			-
I	172 (57.1%)	-
II	59 (19.6%)	-
III	48 (15.9%)	-
IV	20 (6.6%)	-
Primary treatment			-
Surgery	83 (27.1%)	-
Surgery + iodine-131 ablation	212 (69.3%)	-
Surgery + radiotherapy	9 (2.9%)	-
Other	2 (0.7%)	-
Comorbidity (self-report)			<0.001
None	68 (22.2%)	319 (39.9%)
1	70 (22.9%)	208 (26.0%)
≥2	168 (54.9%)	273 (34.1%)
Partnership			0.5
Partner	238 (77.8%)	606 (75.8%)
No partner	68 (22.2%)	194 (24.3%)
Educational level			0.01
High	80 (26.2%)	261 (32.7%)
Middle	192 (63.0%)	491 (61.6%)
Low	33 (10.8%)	45 (5.6%)
Current occupation			0.2
Employed	154 (51.3%)	376 (47.0%)
Not employed	146 (48.7%)	424 (53.0%)

Figure 2. HRQoL of thyroid cancer survivors compared to normative population. (a) Mean EORTC-QLQ-C30 functioning subscale scores (0–100) of survivors in comparison with a Dutch normative population. A higher score means better functioning. An asterisk above the bar indicates a group difference (ANCOVA, p < 0.05, adjusted for comorbidity). (b) Mean EORTC-QLQ-C30 symptom subscale scores (0–100) of survivors in comparison with a Dutch normative population. A higher score indicates more symptoms. An asterisk above the bars indicates a group difference (ANCOVA, p < 0.05, adjusted for comorbidity).

Table II. Mean scores (±SD) of thyroid cancer survivors on EORTC QLQ-C30 and THYCA-QoL scales (0–100) and single items according to years since diagnosis.

	Survivors < 5 years since diagnosis n = 81	Survivors 5–10 years since diagnosis n = 86	Survivors > 10 years since diagnosis n = 137	p-value#
EORTC QLQ-30 functioning+
Global health	73.8 (18.2)	74.4 (21.2)	77.6 (20.2)	0.3
Physical functioning	82.0 (19.7)	83.5 (19.7)	83.0 (19.5)	0.9
Role functioning	79.8 (26.8)	84.3 (24.6)	81.1 (28.3)	0.5
Emotional functioning	83.6 (16.3)	81.1 (22.8)	84.9 (20.2)	0.4
Cognitive functioning	80.4 (20.4)	79.5 (27.3)	84.7 (20.1)	0.2
Social functioning	85.8 (22.1)	82.1 (29.7)	86.6 (22.9)	0.4
EORTC QLQ-30 symptoms++
Fatigue	30.9 (24.6)	29.0 (28.3)	26.0 (23.8)	0.4
Nausea	4.3 (11.1)	5.8 (14.1)	3.1 (8.4)	0.2
Pain	17.5 (25.4)	17.5 (25.9)	16.8 (24.1)	0.9
Dyspnea	14.8 (21.7)	14.9 (22.8)	12.7 (22.2)	0.7
Insomnia	27.2 (29.9)	21.3 (29.7)	20.1 (28.5)	0.2
Appetite	9.1 (21.7)	6.3 (20.4)	3.9 (13.4)	0.1
Constipation	11.9 (21.9)	8.7 (18.0)	9.5 (19.8)	0.6
Diarrhea	7.0 (18.0)	7.9 (20.4)	5.4 (14.2)	0.5
Financial difficulties	10.3 (19.5)	11.5 (26.1)	8.4 (20.7)	0.6
THYCA-QoLscales++
Neuromuscular	27.7 (22.1)	23.8 (23.3)	22.1 (20.7)	0.2
Voice	16.0 (22.7)	12.1 (20.6)	7.3 (14.1)	0.01
Concentration	19.6 (21.5)	18.5 (25.2)	12.1 (18.9)	0.02
Sympathetic	23.3 (29.2)	21.8 (28.3)	14.0 (20.1)	0.02
Throat/mouth	19.3 (20.1)	13.2 (18.1)	8.9 (13.1)	<0.01
Psychological	16.9 (17.1)	15.8 (18.7)	11.9 (14.6)	0.07
Sensory	17.5 (19.2)	14.3 (19.8)	14.2 (19.9)	0.5
THYCA-QoLsingle items++
Problems with scar	16.5 (26.9)	9.1 (23.3)	8.0 (20.1)	0.03
Felt chilly	31.7 (32.9)	26.8 (31.6)	23.4 (30.6)	0.2
Tingling hands/feet	17.7 (27.4)	17.9 (25.1)	11.6 (24.0)	0.1
Gained weight	12.2 (18.6)	12.9 (20.6)	9.4 (17.7)	0.3
Headaches	18.8 (24.8)	19.8 (26.4)	16.4 (23.5)	0.6
Less interest in sex+	24.2 (23.3)	35.6 (25.8)	24.4 (24.4)	<0.01

+Higher scores indicate better functioning; ++Higher scores indicate more symptoms; #p-value of ANOVA for differences between the three groups (results of post-hoc tests are described in text).

Table III. Standardized betas of multiple linear regression analyses evaluating the association of independent variables with the HRQoL scales.

	EORTC QLQ-C30 – scales+
	Global health	Physical functioning	Role functioning	Emotional functioning	Cognitive functioning	Social functioning
Age	−0.01	−0.21**	−0.05	0.19**	0.06	0.11
Years since dx	0.09	0.01	−0.02	−0.02	0.10	−0.03
Sex	0.07	−0.03	0.02	0.07	0.10	0.06
Type of cancer
Papillar	Ref	Ref	Ref	Ref	Ref	Ref
Follicular	−0.05	−0.07	−0.01	0.01	0.04	−0.01
Medullary	−0.05	−0.09	−0.07	0.03	−0.02	−0.01
Primary treatment	−0.06	−0.01	0.01	0.02	−0.11	−0.05
Stage	−0.01	−0.05	−0.05	−0.19**	−0.02	−0.08
Comorbidity	−0.24**	−0.24**	−0.17**	−0.18**	−0.06	−0.07
Partner	−0.21**	−0.24**	−0.21**	−0.12	−0.13*	−0.23**
Education	−0.13*	−0.14*	−0.17**	−0.06	−0.14*	−0.12
R^2	0.14	0.27	0.14	0.08	0.06	0.08

dx, diagnosis.

Age and years since dx were continuous variables in the multivariate model.

Other variables were sex: male vs. female; type of cancer: papillar vs. follicular and papillar vs. medullary; primary treatment: surgery vs. surgery + ablation; disease stage: stage I/II vs. stage III/IV; comorbidity: no comorbid conditions vs. one or more comorbid conditions; partner: partner vs. no partner; educational level: high vs. low.

*< 0.05; **< 0.01; +Higher score indicates better functioning.

Table IV. Standardized betas of multiple linear regression analyses evaluating the association of independent variables with the thyroid cancer specific symptom scales.

	THY-QoL - scales+
	Neuromuscular	Voice	Concentration	Sympathetic	Throat/mouth	Psychological	Sensory
Age	0.08	0.12	−0.19**	−0.01	0.05	−0.11	−0.02
Years since dx	−0.07	−0.17**	−0.08	−0.11	−0.23**	−0.10	−0.05
Sex	−0.01	0.09	−0.11	0.16**	0.02	0.04	−0.02
Type of cancer
Papillar	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Follicular	−0.05	−0.01	−0.07	0.04	0.02	0.02	0.09
Medullar	0.01	0.02	0.01	0.13*	−0.02	−0.06	0.07
Primary treatment	0.10	0.02	0.10	0.07	−0.05	0.06	0.06
Stage	0.05	0.16*	0.13	0.15*	0.16*	0.10	−0.01
Comorbidity	0.26**	−0.02	0.09	0.09	0.17**	0.20**	0.20**
Partner	0.14*	−0.04	0.18**	0.09	−0.03	0.16**	0.01
Education	0.20**	0.03	0.17**	0.06	0.10	0.09	0.05
R^2	0.19	0.10	0.11	0.11	0.15	0.11	0.06

dx, diagnosis.

Age and years since dx were continuous variables in the multivariate model.

Other variables were sex: male vs. female; type of cancer: papillar vs. follicular and papillar vs. medullary; primary treatment: surgery vs. surgery + ablation; disease stage: stage I/II vs. stage III/IV; comorbidity: no comorbid conditions vs. one or more comorbid conditions; partner: partner vs. no partner; educational level: high vs. low.

*< 0.05; **< 0.01; +Higher score is more symptoms.