1 Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden .
2 R&D Department, Stockholms Sjukhem Foundation , Stockholm, Sweden .
Thyroid. 2017 Nov;27(11):1417-1423. doi: 10.1089/thy.2017.0346. Epub 2017 Oct 5.
Despite a good prognosis, fear of recurrence is prevalent, even several years after a diagnosis of differentiated thyroid cancer (DTC). For this reason, the aim of this study was to make an in-depth exploration of anxiety, sources of anxiety, and protective strategies.
In order to capture a broad description of the phenomenon, a purposeful, maximum variation sampling strategy regarding age, sex, stage of disease, educational level, and time since diagnosis was used. In total, 21 patients were included in the study. Semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed with a qualitative content analysis.
Patients with and without recurrences narrated a picture indicating anxiety related to their current situation; future risks and threats were central to this picture. However, they initially minimized or even denied having anxiety, but subsequently described it as a major problem at the end of the interviews. Anxiety was related to risk of recurrence and the risk of developing other cancers, but also to fears of a future situation where no further treatment options were available. Previous experiences of delayed investigations added to these fears. In order to cope, patients developed protective strategies in order to keep evasive and frightening thoughts away. Everyday life, distractions, and focusing on "the small things in life" were examples of such strategies.
Anxiety is a common, although partially hidden, problem in DTC survivors, as they tended to deny it early in the dialogues. As anxiety is clearly related to follow-up routines, these should therefore be revaluated.
尽管预后良好，但即使在诊断出分化型甲状腺癌 (DTC) 多年后，患者仍普遍存在对复发的恐惧。出于这个原因，本研究旨在深入探讨焦虑、焦虑的来源以及保护策略。
为了全面描述这一现象，我们采用了一种针对年龄、性别、疾病阶段、教育程度和诊断后时间的有目的、最大变化的抽样策略。总共纳入了 21 名患者进行研究。对患者进行半结构化访谈并录音，逐字转录，并采用定性内容分析进行分析。
有复发和无复发的患者描述的情况均表明他们对当前状况感到焦虑；未来的风险和威胁是这种情况的核心。然而，他们最初最小化甚至否认自己有焦虑，但在访谈结束时描述为一个主要问题。焦虑与复发风险和发生其他癌症的风险有关，但也与对未来无法获得进一步治疗选择的情况的恐惧有关。以前延迟检查的经历加剧了这些恐惧。为了应对这些情况，患者发展出保护策略，以避免回避和令人恐惧的想法。日常生活、分散注意力和关注“生活中的小事情”就是这些策略的例子。
焦虑是 DTC 幸存者常见的问题，尽管部分情况下被隐藏，因为他们在对话早期往往否认这一点。由于焦虑显然与随访常规有关，因此应重新评估这些常规。
