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Open Access 01-12-2021 | Affective Disorder | Endocrine Tumors

Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules

Authors: Max A. Schumm, MD, Dalena T. Nguyen, MPH, Jiyoon Kim, MSc, Chi-Hong Tseng, PhD, Amy Y. Chow, MD, Na Shen, MD, Masha J. Livhits, MD

Published in: Annals of Surgical Oncology | Issue 13/2021

Abstract

Background

Molecular testing can refine the risk of malignancy in cytologically indeterminate thyroid nodules and can reduce the need for diagnostic thyroidectomy. However, quality of life (QOL) in patients mananged with molecular testing is not well studied.

Objective

We aimed to assess the QOL of patients undergoing surveillance after a benign molecular test result, or thyroidectomy after a suspicious molecular test result.

Methods

This prospective longitudinal follow-up of the Effectiveness of Molecular Testing Techniques for Diagnosis of Indeterminate Thyroid Nodules randomized trial utilized the Thyroid-Related Patient-Reported Outcome, 39-item version (ThyPro-39) to assess the QOL of patients with indeterminate cytology on thyroid fine needle aspiration (FNA) biopsy. All patients underwent molecular testing at the time of initial FNA. A mixed-effect model was used to determine changes in QOL over time.

Results

Of 252 eligible patients, 174 completed the assessment (69% response rate). Molecular test results included 72% (n = 124) benign and 28% (n = 50) suspicious. ThyPro-39 scores of benign molecular test patients were unchanged from baseline (following initial FNA and molecular test results) to 18 months of ultrasound surveillance. Baseline symptoms of goiter, anxiety, and depression were more severe for patients with suspicious compared with benign molecular test results. At a median of 8 months after thyroidectomy, suspicious molecular test patients reported improved symptoms of goiter, anxiety, and depression.

Conclusion

A benign molecular test provides sustained QOL throughout ultrasound surveillance, without worsening anxiety or depression relating to the risk of malignancy. Definitive surgery results in improvement of QOL in patients with suspicious molecular tests.

Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7. https://doi.org/10.1001/jama.295.18.2164.CrossRefPubMed

Cibas ES, Ali SZ. The 2017 bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6. https://doi.org/10.1089/thy.2017.0500.CrossRefPubMed

Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S. Implications of the proposed thyroid fine-needle aspiration category of “follicular lesion of undetermined significance”: a five-year multi-institutional analysis. Diagn Cytopathol. 2009;37(10):710–4. https://doi.org/10.1002/dc.21093.CrossRefPubMed

Sauter JL, Lehrke H, Zhang X, et al. Assessment of the bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2019;152(4):502–11. https://doi.org/10.1093/ajcp/aqz076.CrossRefPubMedPubMedCentral

Valderrabano P, McIver B. Evaluation and management of indeterminate thyroid nodules: the revolution of risk stratification beyond cytological diagnosis. Cancer Control. 2017;24(5):1073274817729231. https://doi.org/10.1177/1073274817729231.CrossRefPubMedPubMedCentral

Yeh MW. The year in surgical thyroidology. Thyroid. 2020;30(1):20–4. https://doi.org/10.1089/thy.2019.0767.CrossRefPubMed

Burch HB, Burman KD, Cooper DS, Hennessey JV, Vietor NO. A 2015 survey of clinical practice patterns in the management of thyroid nodules. J Clin Endocrinol Metab. 2016;101(7):2853–62. https://doi.org/10.1210/jc.2016-1155.CrossRefPubMed

Applewhite MK, James BC, Kaplan SP, et al. Quality of life in thyroid cancer is similar to that of other cancers with worse survival. World J Surg. 2016;40(3):551–61. https://doi.org/10.1007/s00268-015-3300-5.CrossRefPubMed

Nickel B, Tan T, Cvejic E, et al. Health-related quality of life after diagnosis and treatment of differentiated thyroid cancer and association with type of surgical treatment. JAMA Otolaryngol Head Neck Surg. 2019;145(3):231–8. https://doi.org/10.1001/jamaoto.2018.3870.CrossRefPubMedPubMedCentral

10.

Hedman C, Djärv T, Strang P, Lundgren CI. Determinants of long-term quality of life in patients with differentiated thyroid carcinoma: a population-based cohort study in Sweden. Acta Oncol. 2016;55(3):365–9. https://doi.org/10.3109/0284186X.2015.1102965.CrossRefPubMed

11.

Bresner L, Banach R, Rodin G, Thabane L, Ezzat S, Sawka AM. Cancer-related worry in Canadian thyroid cancer survivors. J Clin Endocrinol Metab. 2015;100(3):977–85. https://doi.org/10.1210/jc.2014-3169.CrossRefPubMed

12.

James BC, Aschebrook-Kilfoy B, White MG, et al. Quality of life in thyroid cancer-assessment of physician perceptions. J Surg Res. 2018;226:94–9. https://doi.org/10.1016/j.jss.2017.11.069.CrossRefPubMed

13.

Wong CW, Schumm MA, Zhu CY, et al. Quality of life following molecular marker testing for indeterminate thyroid nodules. Endocr Pract. 2020;26(9):960–6. https://doi.org/10.4158/EP-2020-0101.CrossRefPubMed

14.

Livhits MJ, Zhu CY, Kuo EJ, et al. Effectiveness of molecular testing techniques for diagnosis of indeterminate thyroid nodules: a randomized clinical trial. JAMA Oncol. 2021;7(1):70–7. https://doi.org/10.1001/jamaoncol.2020.5935.CrossRefPubMed

15.

Patel KN, Angell TE, Babiarz J, et al. Performance of a genomic sequencing classifier for the preoperative diagnosis of cytologically indeterminate thyroid nodules. JAMA Surg. 2018;153(9):817–24. https://doi.org/10.1001/jamasurg.2018.1153.CrossRefPubMedPubMedCentral

16.

Steward DL, Carty SE, Sippel RS, et al. Performance of a multigene genomic classifier in thyroid nodules with indeterminate cytology: a prospective blinded multicenter study. JAMA Oncol. 2019;5(2):204–12. https://doi.org/10.1001/jamaoncol.2018.4616.CrossRefPubMed

17.

Watt T, Bjorner JB, Groenvold M, et al. Development of a short version of the thyroid-related patient-reported outcome ThyPRO. Thyroid. 2015;25(10):1069–79. https://doi.org/10.1089/thy.2015.0209.CrossRefPubMed

18.

Harrell RM, Duh QY, Randolph GW, Patel KN, Kloos RT. Reduced surgery through afirma GEC: impact to date and potential for the future. In: American Association of Clinical Endocrinologists annual meeting; 2017; Austin, TX.

19.

Chen JC, Pace SC, Chen BA, Khiyami A, McHenry CR. Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda System for Reporting Thyroid Cytopathology. Surgery. 2012;152(6):1037–44. https://doi.org/10.1016/j.surg.2012.08.052.CrossRefPubMed

20.

Allen L, Al Afif A, Rigby MH, et al. The role of repeat fine needle aspiration in managing indeterminate thyroid nodules. J Otolaryngol Head Neck Surg. 2019;48(1):16. https://doi.org/10.1186/s40463-019-0338-7.CrossRefPubMedPubMedCentral

21.

Pitt SC, Saucke MC, Wendt EM, et al. Patients’ reaction to diagnosis with thyroid cancer or an indeterminate thyroid nodule. Thyroid. 2021;31(4):580–8.CrossRef

22.

Jensen CB, Saucke MC, Francis DO, Voils CI, Pitt SC. From overdiagnosis to overtreatment of low-risk thyroid cancer: a thematic analysis of attitudes and beliefs of endocrinologists, surgeons, and patients. Thyroid. 2020;30(5):696–703. https://doi.org/10.1089/thy.2019.0587.CrossRefPubMedPubMedCentral

23.

Deary IJ, Smart A, Wilson JA. Depression and “hassles” in globus pharyngis. Br J Psychiatry. 1992;161:115–7. https://doi.org/10.1192/bjp.161.1.115.CrossRefPubMed

24.

Aschebrook-Kilfoy B, James B, Nagar S, et al. Risk factors for decreased quality of life in thyroid cancer survivors: initial findings from the North American Thyroid cancer survivorship study. Thyroid. 2015;25(12):1313–21. https://doi.org/10.1089/thy.2015.0098.CrossRefPubMedPubMedCentral

25.

Henry M, Frenkiel S, Chartier G, et al. Thyroid cancer patients receiving an interdisciplinary team-based care approach (ITCA-ThyCa) appear to display better outcomes: Program evaluation results indicating a need for further integrated care and support. Psychooncology. 2018;27(3):937–45. https://doi.org/10.1002/pon.4590.CrossRefPubMed

26.

Harrell RM, Eyerly-Webb SA, Golding AC, Edwards CM, Bimston DN. Statistical comparison of AFIRMA GSC and AFIRMA GEC outcomes in a community endocrine surgical practice: early findings. Endocr Pract. 2019;25(2):161–4. https://doi.org/10.4158/EP-2018-0395.CrossRefPubMed

27.

Angell TE, Heller HT, Cibas ES, et al. Independent comparison of the afirma genomic sequencing classifier and gene expression classifier for cytologically indeterminate thyroid nodules. Thyroid. 2019;29(5):650–6. https://doi.org/10.1089/thy.2018.0726.CrossRefPubMed

28.

Zhu CY, Donangelo I, Gupta D, et al. Outcomes of indeterminate thyroid nodules managed nonoperatively after molecular testing. J Clin Endocrinol Metab. 2021;106(3):e1240–7. https://doi.org/10.1210/clinem/dgaa887.CrossRefPubMed

Title: Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules
Authors: Max A. Schumm, MD
Dalena T. Nguyen, MPH
Jiyoon Kim, MSc
Chi-Hong Tseng, PhD
Amy Y. Chow, MD
Na Shen, MD
Masha J. Livhits, MD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Affective Disorder
Affective Disorder
Goiter
Thyroidectomy
Thyroidectomy
Anxiety
Published in: Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10375-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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