Patient-Reported Outcomes Three Years After Deciding on Surgery or Active Surveillance for Small, Low-Risk Papillary Thyroid Cancer: Results of a Prospective Cohort Study

Abstract

BACKGROUND: Long-term quality of life is an important consideration of patients in deciding on disease management options for low-risk papillary thyroid cancer (PTC). METHODS: We conducted a prospective cohort study of Canadian patients who were diagnosed with small (<2 cm in maximal diameter), low-risk papillary thyroid cancer (PTC) and were given the choice of active surveillance (AS) or immediate surgery. We report the results of a self-administered questionnaire on patient-reported outcomes (PROs) that was completed approximately three years after the initial disease management choice. PROs included overall and subscale scores from questionnaires, including those on quality of life (EORTC QLQ-C30, EORTC THY-34), the Assessment of Survivor Concerns, the Decision Regret Scale, and the Generalized Anxiety Disorder 7-item Scale. We compared the results according to the initial disease management choice and according to the disease management status at the time of questionnaire completion. RESULTS: The participant response rate was 64% (120/188), including 98 individuals who chose AS and 22 who chose immediate surgery. The median duration of follow-up at the time of questionnaire completion was 42 months (interquartile range [IQR] = 39, 46). After statistical adjustment for multiple comparisons, there were no significant differences in the overall scores or subscales of any of the questionnaires between patients who chose AS and those who chose immediate surgery. However, in a secondary analysis, patients who crossed over from AS to surgery experienced greater cancer-related worry as well as overall worry (p = 0.021 for each) and decision regret (p = 0.031) as compared with patients who remained under AS and those who initially chose surgery. CONCLUSIONS: We observed that PROs do not significantly differ between patients who chose AS and those who chose immediate surgery a few years after the initial disease management choice. However, patients who crossover from AS to surgery may experience greater cancer-related worry and decision regret.