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Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 6/2020

01-12-2020 | Thyroid Cancer | Original Research

Looking under the hood of “the Cadillac of cancers:” radioactive iodine-related craniofacial side effects among patients with thyroid cancer

Authors: Samantha A. Diamond-Rossi, Jacqueline Jonklaas, Roxanne E. Jensen, Charlene Kuo, Selma Stearns, Giuseppe Esposito, Bruce J. Davidson, George Luta, Gary Bloom, Kristi D. Graves

Published in: Journal of Cancer Survivorship | Issue 6/2020

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Abstract

Purpose

Despite having a generally favorable prognosis, differentiated thyroid cancer is known to have a significant, long-term impact on the quality of life of survivors. We wished to investigate short- and long-term effects among thyroid cancer survivors following radioactive iodine therapy.

Methods

We conducted eight focus groups (N = 47) to understand patients’ experiences of short- and long-term effects after radioactive iodine treatment and the impact these treatment-related side effects had on patients’ quality of life. We elicited responses regarding experiences with side effects following radioactive iodine treatment, particularly salivary, lacrimal, and nasal symptoms. We transcribed audiotapes and conducted qualitative analyses to identify codes and themes.

Results

We identified eight broad themes from the qualitative analyses. Themes reflecting physical symptoms included dry mouth, salivary gland dysfunction, altered taste, eye symptoms such as tearing or dryness, and epistaxis. Psychosocial themes included lack of knowledge and preparation for treatment, regret of treatment, and distress that thyroid cancer is labeled as a “good cancer.”

Conclusions

Thyroid cancer survivors reported a wide range of radioactive iodine treatment-related effects and psychosocial concerns that appear to reduce quality of life. The psychosocial concerns reported by participants underscore the significant unmet information and support needs prior to and following RAI treatment among individuals diagnosed with thyroid cancer.

Implications for Cancer Survivors

Future research is needed to help both patients and physicians understand the effect of radioactive iodine on quality of life, and to better assess the benefits versus the risks of radioactive iodine therapy.
Literature
1.
Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA. 2017;317(13):1338–48.PubMed
2.
Chow SM, Law SC, Mendenhall WM, Au SK, Chan PT, Leung TW, et al. Papillary thyroid carcinoma: prognostic factors and the role of radioiodine and external radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52(3):784–95.PubMed
3.
Chow SM, Yau S, Kwan CK, Poon PC, Law SC. Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition. Endocr Relat Cancer. 2006;13(4):1159–72.PubMed
4.
Tuttle RM, Haddad RI, Ball DW, Byrd D, Dickson P, Duh QY, et al. Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw. 2014;12(12):1671–80 quiz 80.PubMed
5.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.PubMedPubMedCentral
6.
Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16(12):1229–42.PubMed
7.
Luster M, Aktolun C, Amendoeira I, Barczynski M, Bible KC, Duntas LH, et al. European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium. Thyroid. 2019;29(1):7–26.PubMed
8.
American Thyroid Association Taskforce On Radioiodine S, Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. 2011;21(4):335–46.
9.
Nixon IJ, Ganly I, Patel SG, Palmer FL, Di Lorenzo MM, Grewal RK, et al. The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification. Thyroid. 2013;23(6):683–94.PubMed
10.
Sacks W, Wong RM, Bresee C, Braunstein GD. Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid. 2015;25(4):377–85.PubMed
11.
Park KW, Wu JX, Du L, Leung AM, Yeh MW, Livhits MJ. Decreasing use of radioactive iodine for low-risk thyroid cancer in California, 1999 to 2015. J Clin Endocrinol Metab. 2018;103(3):1095–101.PubMed
12.
Mendoza A, Shaffer B, Karakla D, Mason ME, Elkins D, Goffman TE. Quality of life with well-differentiated thyroid cancer: treatment toxicities and their reduction. Thyroid. 2004;14(2):133–40.PubMed
13.
Lin WY, Shen YY, Wang SJ. Short-term hazards of low-dose radioiodine ablation therapy in postsurgical thyroid cancer patients. Clin Nucl Med. 1996;21(10):780–2.PubMed
14.
Caglar M, Tuncel M, Alpar R. Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment. Clin Nucl Med. 2002;27(11):767–71.PubMed
15.
Solans R, Bosch JA, Galofre P, Porta F, Rosello J, Selva-O'Callagan A, et al. Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J Nucl Med. 2001;42(5):738–43.PubMed
16.
Malpani BL, Samuel AM, Ray S. Quantification of salivary gland function in thyroid cancer patients treated with radioiodine. Int J Radiat Oncol Biol Phys. 1996;35(3):535–40.PubMed
17.
Hoelzer S, Steiner D, Bauer R, Reiners C, Farahati J, Hundahl SA, et al. Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany. Eur J Nucl Med. 2000;27(10):1465–72.PubMed
18.
Nakada K, Ishibashi T, Takei T, Hirata K, Shinohara K, Katoh S, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med. 2005;46(2):261–6.PubMed
19.
Allweiss P, Braunstein GD, Katz A, Waxman A. Sialadenitis following I-131 therapy for thyroid carcinoma: concise communication. J Nucl Med. 1984;25(7):755–8.PubMed
20.
Grewal RK, Larson SM, Pentlow CE, Pentlow KS, Gonen M, Qualey R, et al. Salivary gland side effects commonly develop several weeks after initial radioactive iodine ablation. J Nucl Med. 2009;50(10):1605–10.PubMed
21.
Chow SM. Side effects of high-dose radioactive iodine for ablation or treatment of differentiated thyroid carcinoma. J HK Coll Radiol. 2005;8:127–35.
22.
Kloos RT, Duvuuri V, Jhiang SM, Cahill KV, Foster JA, Burns JA. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. 2002;87(12):5817–20.PubMed
23.
Zettinig G, Hanselmayer G, Fueger BJ, Hofmann A, Pirich C, Nepp J, et al. Long-term impairment of the lacrimal glands after radioiodine therapy: a cross-sectional study. Eur J Nucl Med Mol Imaging. 2002;29(11):1428–32.PubMed
24.
Van Nostrand D, Neutze J, Atkins F. Side effects of "rational dose" iodine-131 therapy for metastatic well-differentiated thyroid carcinoma. J Nucl Med. 1986;27(10):1519–27.PubMed
25.
Jonklaas J. Nasal symptoms after radioiodine therapy: a rarely described side effect with similar frequency to lacrimal dysfunction. Thyroid. 2014;24(12):1806–14.PubMedPubMedCentral
26.
Goswami S, Peipert BJ, Mongelli MN, Kurumety SK, Helenowski IB, Yount SE, et al. Clinical factors associated with worse quality-of-life scores in United States thyroid cancer survivors. Surgery. 2019.
27.
Mols F, Schoormans D, Smit JWA, Netea-Maier RT, Links TP, van der Graaf WTA, et al. Age-related differences in health-related quality of life among thyroid cancer survivors compared with a normative sample: Results from the PROFILES Registry. Head Neck. 2018;40(10):2235–45.PubMed
28.
Wang T, Jiang M, Ren Y, Liu Q, Zhao G, Cao C, et al. Health-related quality of life of community thyroid cancer survivors in Hangzhou, China. Thyroid. 2018;28(8):1013–23.PubMed
29.
Molenaar RJ, Pleyer C, Radivoyevitch T, Sidana S, Godley A, Advani AS, et al. Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine. Leukemia. 2018;32(4):952–9.PubMed
30.
Sawka AM, Naeem A, Jones J, Lowe J, Segal P, Goguen J, et al. Persistent posttreatment fatigue in thyroid cancer survivors: a scoping review. Endocrinol Metab Clin North Am. 2014;43(2):475–94.PubMed
31.
Rogers SN, Mepani V, Jackson S, Lowe D. Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer. Br J Oral Maxillofac Surg. 2017;55(7):666–73.PubMed
32.
Lee JI, Kim SH, Tan AH, Kim HK, Jang HW, Hur KY, et al. Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea. Health Qual Life Outcomes. 2010;8:101.PubMedPubMedCentral
33.
Duan H, Gamper E, Becherer A, Hoffmann M. Quality of life aspects in the management of thyroid cancer. Oral Oncol. 2015;51(6):S1–5.PubMed
34.
Sawka AM, Goldstein DP, Brierley JD, Tsang RW, Rotstein L, Ezzat S, et al. The impact of thyroid cancer and post-surgical radioactive iodine treatment on the lives of thyroid cancer survivors: a qualitative study. PLoS One. 2009;4(1):e4191.PubMedPubMedCentral
35.
Aschebrook-Kilfoy B, Ferguson BA, Angelos P, Kaplan EL, Grogan RH, Gibbons RD. development of the ThyCAT: a clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors. Surgery. 2018;163(1):137–42.PubMed
36.
James BC, Aschebrook-Kilfoy B, White MG, Applewhite MK, Kaplan SP, Angelos P, et al. Quality of life in thyroid cancer-assessment of physician perceptions. J Surg Res. 2018;226:94–9.PubMed
37.
Easley J, Miedema B, Robinson L. It's the "good" cancer, so who cares? Perceived lack of support among young thyroid cancer survivors. Oncol Nurs Forum. 2013;40(6):596–600.PubMed
38.
Randle RW, Bushman NM, Orne J, Balentine CJ, Wendt E, Saucke M, et al. Papillary Thyroid cancer: the good and bad of the "good cancer". Thyroid. 2017;27(7):902–7.PubMedPubMedCentral
39.
Goldfarb M, Casillas J. Unmet information and support needs in newly diagnosed thyroid cancer: comparison of adolescents/young adults (AYA) and older patients. J Cancer Surviv. 2014;8(3):394–401.PubMed
40.
41.
Sandelowski M. Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Res Nurs Health. 2000;23(3):246–55.PubMed
42.
Miles MB, Huberman M. Qualitative Data Analysis. Thousand Oaks: SAGE Publications; 1994.
43.
Choi Y, Lee JH, Kim YH, Lee YS, Chang HS, Park CS, et al. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol. 2014;26(6):693–9.PubMedPubMedCentral
44.
Nygaard B, Bastholt L, Bennedbaek FN, Klausen TW, Bentzen J. A placebo-controlled, blinded and randomised study on the effects of recombinant human thyrotropin on quality of life in the treatment of thyroid cancer. Eur Thyroid J. 2013;2(3):195–202.PubMedPubMedCentral
45.
Saeed O, Bernstein LJ, Fazelzad R, Samuels M, Burmeister LA, Thabane L, et al. Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2019;13(2):231–43.PubMed
46.
Morley S, Goldfarb M. Support needs and survivorship concerns of thyroid cancer patients. Thyroid. 2015;25(6):649–56.PubMed
47.
Sawka AM, Straus S, Gafni A, Brierley JD, Tsang RW, Rotstein L, et al. How can we meet the information needs of patients with early stage papillary thyroid cancer considering radioactive iodine remnant ablation? Clin Endocrinol (Oxf). 2011;74(4):419–23.PubMedPubMedCentral
48.
Hyun YG, Alhashemi A, Fazelzad R, Goldberg AS, Goldstein DP, Sawka AM. A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer. Thyroid. 2016;26(9):1239–50.PubMed
49.
Husson O, Mols F, Oranje WA, Haak HR, Nieuwlaat WA, Netea-Maier RT, et al. Unmet information needs and impact of cancer in (long-term) thyroid cancer survivors: results of the PROFILES registry. Psychooncology. 2014;23(8):946–52.PubMed
50.
Wallner LP, Reyes-Gastelum D, Hamilton AS, Ward KC, Hawley ST, Haymart MR. Patient-Perceived Lack of Choice in Receipt of Radioactive Iodine for Treatment of Differentiated Thyroid Cancer. J Clin Oncol. 2019:JCO1802228.
51.
Blackburn BE, Ganz PA, Rowe K, Snyder J, Wan Y, Deshmukh V, et al. Reproductive and gynecological complication risks among thyroid cancer survivors. J Cancer Surviv. 2018;12(5):702–11.PubMedPubMedCentral
52.
Yaish I, Azem F, Gutfeld O, Silman Z, Serebro M, Sharon O, et al. A single radioactive iodine treatment has a deleterious effect on ovarian reserve in women with thyroid cancer: results of a prospective pilot study. Thyroid. 2018;28(4):522–7.PubMed
53.
Bourcigaux N, Rubino C, Berthaud I, Toubert ME, Donadille B, Leenhardt L, et al. Impact on testicular function of a single ablative activity of 3.7 GBq radioactive iodine for differentiated thyroid carcinoma. Hum Reprod. 2018.
54.
Davies L, Hendrickson CD, Hanson GS. Experience of US Patients who self-identify as having an overdiagnosed thyroid cancer: a qualitative analysis. JAMA Otolaryngol Head Neck Surg. 2017;143(7):663–9.PubMedPubMedCentral
55.
Jeong SY, Kim HW, Lee SW, Ahn BC, Lee J. Salivary gland function 5 years after radioactive iodine ablation in patients with differentiated thyroid cancer: direct comparison of pre- and postablation scintigraphies and their relation to xerostomia symptoms. Thyroid. 2013;23(5):609–16.PubMedPubMedCentral
56.
Jonklaas J, Wang H, Esposito G. Salivary function after radioiodine therapy: poor correlation between symptoms and salivary scintigraphy. Front Endocrinol (Lausanne). 2015;6:100.
Metadata
Title
Looking under the hood of “the Cadillac of cancers:” radioactive iodine-related craniofacial side effects among patients with thyroid cancer
Authors
Samantha A. Diamond-Rossi
Jacqueline Jonklaas
Roxanne E. Jensen
Charlene Kuo
Selma Stearns
Giuseppe Esposito
Bruce J. Davidson
George Luta
Gary Bloom
Kristi D. Graves
Publication date
01-12-2020
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 6/2020
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-020-00897-5

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